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Ribavirin therapy: implementation of hospital guidelines and effect on usage and cost of therapy
T J Feldstein1, J L Swegarden, G F Atwood
1Department of Clinical Pharmacy, MeritCare Childrens Hospital, Fargo, ND, USA.
Insights
Implementing hospital guidelines significantly reduced inappropriate ribavirin use in infants, leading to cost savings. This study highlights the importance of adhering to American Academy of Pediatrics (AAP) recommendations for antiviral therapy.
Area of Science:
- Pediatric critical care medicine
- Infectious disease management
- Health services research
Background:
- The American Academy of Pediatrics (AAP) advises reserving ribavirin for severely ill infants at high risk of morbidity and mortality.
- Current practices in ribavirin utilization may not consistently align with established clinical guidelines.
Purpose of the Study:
- To assess the current use of ribavirin in infants at our institution.
- To implement tailored hospital guidelines for ribavirin administration.
- To establish a surveillance system for monitoring ribavirin therapy and its impact on usage and costs.
Main Methods:
- A retrospective analysis compared initial ribavirin use against AAP recommendations.
- Hospital-specific guidelines were developed and implemented.
- Ribavirin therapy was prospectively reevaluated over a two-year period post-implementation.
Main Results:
- Initially, only 67% of infants met AAP guidelines, with 19% receiving inappropriate regimens, incurring significant costs.
- Post-guideline implementation, ribavirin use decreased by 35%, with 96% of recipients meeting criteria.
- Estimated cost avoidance and reduced charges were substantial, particularly for acute bronchiolitis cases.
Conclusions:
- A significant proportion of infants received ribavirin inconsistently with AAP guidelines before intervention.
- Adoption of modified AAP guidelines and a surveillance system led to a marked reduction in ribavirin use.
- The study demonstrates significant cost savings and improved adherence to evidence-based practices.
Objective:
The American Academy of Pediatrics (AAP) recommends that ribavirin be reserved for infants who are severely ill and who are at high risk of morbidity and mortality, based on underlying clinical conditions. The purpose of this study was to evaluate current ribavirin use in our institution, implement hospital-specific guidelines for use, develop a prospective surveillance system to monitor ribavirin therapy, and evaluate the impact of these guidelines on subsequent use and cost of therapy.
Methods:
Ribavirin use was compared with the recommendations of the AAP. Results were presented to the professional staff, and hospital guidelines were implemented. Ribavirin therapy was reevaluated in a 2-year period after hospital guidelines were implemented.
Results:
In the initial evaluation period, only 67% of the ribavirin recipients met the AAP guidelines for use, and 19% received an inappropriate treatment regimen. The total cost and billed patient charges for ribavirin recipients who did not meet the guidelines for use in period 1 was $60,638 and $127,940, respectively. Over the next 2 years (period 2) after the implementation of hospital guidelines, the percentage of patients who received ribavirin decreased 35%, and approximately 96% of ribavirin recipients met the established criteria. Based on the decrease in the percentage of patients who received ribavirin in period 2 (41% versus 63%), the estimated cost avoidance and reduction in billed patient charges in period 2 was $55,540 and $117,334, respectively. This represents an estimated reduction in hospital costs and billed patient charges of $46,283 and $97,778 per 100 admissions for acute bronchiolitis.
Conclusions:
Before the implementation of hospital guidelines for use, a substantial percent of patients received ribavirin not consistent with the recommendations of the AAP. Following the adoption of a modified version of the AAP guidelines for our institution and the use of a multidisciplinary surveillance system for monitoring ribavirin therapy, we observed a substantial decrease in the overall ribavirin use. This has resulted in a significant savings in terms of cost avoidance and reduced billed patient charges.
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