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Parental emotional and time costs predict compliance with respiratory syncytial virus prophylaxis
James M Robbins1, John M Tilford, Stephen R Gillaspy
1Department of Pediatrics, Center for Applied Research and Evaluation, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock 72202, USA. RobbinsJamesM@uams.edu
Insights
Respiratory syncytial virus immune globulin (RSV-IG) treatment causes greater parental distress and time costs than palivizumab, leading to lower adherence. These hidden costs significantly impact treatment completion for premature infants.
Area of Science:
- Pediatrics
- Immunology
- Public Health
Background:
- Two agents, RSV immune globulin (RSV-IG) and palivizumab, are effective in preventing respiratory syncytial virus (RSV) hospitalization in premature infants.
- RSV-IG is associated with higher parental emotional and time costs, potentially impacting treatment adherence.
Purpose of the Study:
- To compare the emotional distress and time costs of RSV-IG and palivizumab treatments.
- To determine how these costs influence adherence to recommended monthly prophylaxis.
Main Methods:
- Telephone surveys were conducted with parents of infants receiving RSV-IG (n=82) and palivizumab (n=61).
- Measurements included infant distress during treatment, parental distress, parental time costs, and adherence rates.
Main Results:
- Half of RSV-IG recipients' parents witnessed infant distress; 61% were upset by needle sticks. Palivizumab had minimal parental distress.
- RSV-IG recipients completed 62% of recommended treatments versus 86% for palivizumab.
- Increased parental distress and time costs significantly explained lower RSV-IG adherence.
Conclusions:
- Emotional and time costs for RSV-IG treatment are substantially higher than for palivizumab, predicting lower adherence.
- Economic evaluations of medical procedures should incorporate these "hidden" costs to accurately reflect adherence impacts.
Background:
Two agents are effective in preventing respiratory syncytial virus (RSV) hospitalization in premature infants: RSV immune globulin (RSV-IG) and palivizumab. RSV-IG is associated with greater parental emotional and time costs, which may account for the more limited adherence to recommended monthly treatment with this agent.
Objectives:
To compare the emotional distress and time costs associated with RSV-IG and palivizumab treatments and to determine the influence of these costs on treatment adherence.
Methods:
We surveyed parents of 82 infants who received RSV-IG (90% of eligible) and parents of 61 infants who received palivizumab (87% of eligible) at Arkansas Children's Hospital by telephone. We measured infant distress during treatment, parental distress, parental time costs, and adherence with recommended monthly prophylaxis.
Results:
Half of parents of RSV-IG recipients witnessed their infant in distress during infusion, over half (61%) were upset by observing the needle stick, and 22% observed infusion in the scalp. Fewer than 5% of parents of palivizumab recipients observed their infant in distress or were themselves distressed during treatment. A quarter of parents took time off from work for RSV-IG or palivizumab treatment. RSV-IG recipients completed 62% of recommended monthly treatments compared with 86% completed by palivizumab recipients. Increased parental distress and time costs largely accounted for the reduction in adherence to monthly treatment among RSV-IG recipients.
Conclusions:
The emotional and time costs of RSV-IG treatment far exceed those of palivizumab and predict substantial differences in treatment adherence between the 2 agents. The impact of hidden costs on treatment adherence should be included in economic evaluations of medical procedures.