title: Parental emotional and time costs predict compliance with respiratory syncytial virus prophylaxis.
abstract: 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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Department 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
authors.forename: James M
authors.initials: JM
authors.lastname: Robbins
authors.forename: John M
authors.initials: JM
authors.lastname: Tilford
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Gillaspy
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Shaw
authors.forename: Donald D
authors.initials: DD
authors.lastname: Simpson
authors.forename: Richard F
authors.initials: RF
authors.lastname: Jacobs
authors.forename: J Gary
authors.initials: JG
authors.lastname: Wheeler
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents / Q000009:adverse effects; D001131:Arkansas; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D016018:Least-Squares Analysis; D015999:Multivariate Analysis; D010146:Pain / Q000209:etiology; D000069455:Palivizumab; D010290:Parents / Q000523:psychology; D010349:Patient Compliance; D018357:Respiratory Syncytial Virus Infections / Q000517:prevention & control*; D013315:Stress, Psychological / Q000209:etiology; D013997:Time Factors
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D000069455:Palivizumab