RSV Immune Globulin Prophylaxis: Is an Ounce of Prevention Worth a Pound of Cure?

* Abbreviations: RSV-IVIG = : respiratory syncytial virus immune globulin, intravenous • AAP = : American Academy of Pediatrics In this issue of Pediatrics, Joffe et al reported limited cost-effectiveness of the immune globulin products (RSV-IGIV [Respigam] or palivizumab [Synagis]) to prevent RSV hospitalization. Several assumptions strongly favoring immune globulin prophylaxis were used in their analyses. The authors concluded that current AAP recommendations regarding RSV immune globulin products may be too broad because a lack of cost-effectiveness observed.1 In only 1 of the 8 subgroup analyses (Group A infants with gestation <32 weeks, oxygen requirement 28 days, neonatal intensive care unit discharge between September and November, and prophylaxis with palivizumab), was cost-effectiveness in terms of cost per life-year saved and cost to avoid hospitalization seemingly approached. It is important in cost-effectiveness studies for reviewers and readers to carefully consider assumptions made because results may be profoundly affected. To their credit, the authors carefully acknowledged intentionally biasing their assumptions in the direction of benefiting the immune globulin therapies. For example, one assumption made was that only 4 doses of a RSV immune globulin preparation would be necessary to prevent RSV disease each season. In previous efficacy studies, 5 doses were generally administered. The …