Palivizumab utilization and compliance: trends in respiratory syncytial virus prophylaxis in Florida.
OBJECTIVE
To analyze adherence to guidelines to prevent respiratory syncytial virus hospitalization and to a monthly immunoprophylaxis schedule in the absence of prior authorization requirements.


METHODS
Among Florida Medicaid fee-for-service recipients 0 to 2 years of age from the 1998/1999 season through the 2004/2005 season with available birth certificates, we identified indications for palivizumab prophylaxis based on claims data. At least 4 doses of palivizumab in the 5 core season-months were considered full season coverage.


RESULTS
Of 302 101 children-seasons, 6089 were associated with 24 469 doses of palivizumab. In the 2004/2005 season, 73.6% of children with chronic lung disease received immunoprophylaxis, 67.6% children with gestational age <32 weeks, 37% with congenital heart disease, 26.4% with cystic fibrosis, and 19.4% with severe immunodeficiency. Multiple indications increased the likelihood for prophylaxis from 34.9% to 80.4%. Full season coverage was consistent across indications at approximately 70%. From the 1998/1999 season through the 2004/2005 season, 8038 doses were administered during 2051 children-seasons without any indication; mostly (69.6%) where premature children had exceeded the recommended age range for prophylaxis.


CONCLUSIONS
High utilization rates were found in children with multiple indications, and compliance with a monthly schedule was consistently high. One third of doses were administered outside of guidelines, suggesting suboptimal utilization of resources in the absence of prior authorization.
Hampp
Christian
C
Department Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL. Electronic address: champp@ufl.edu.
Saidi
Arwa S
AS
Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL.
Winterstein
Almut G
AG
Department Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL; Department of Epidemiology and Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, FL.
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents / Q000627:therapeutic use*; D005431:Florida; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008484:Medicaid; D000069455:Palivizumab; D010818:Practice Patterns, Physicians'; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors; D014481:United States
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents; D000069455:Palivizumab