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James M. Robbins, PhD; John M. Tilford, PhD; Richard F. Jacobs, MD; J. Gary Wheeler, MD; Stephen R. Gillaspy, BA; Gordon E. Schutze, MD

Arch Pediatr Adolesc Med. 1998;152:358-366.

Objectives  To estimate how many infants in selected high-risk subgroups would require treatment with respiratory syncytial virus immune globulin (RSV-IG) to avoid 1 hospital admission and to determine whether this is economically justified.

Design  Cost-benefit analysis. Data from 3 randomized controlled trials of RSV-IG are used to estimate the number needed to treat to prevent 1 hospital admission for respiratory syncytial virus infection. The threshold number needed to treat is computed according to a formula incorporating costs and benefits of RSV-IG prophylaxis. Estimates of the willingness to pay were obtained from a sample of 39 health care providers (35 physicians and 4 nurses).

Main Outcome Measures  The number needed to treat to prevent 1 hospital admission for respiratory syncytial virus infection. The threshold number needed to treat that would balance costs with benefits.

Results  More than 16 (95% confidence interval, 12.5-23.8) infants would need to be treated with RSV-IG to avoid 1 hospital admission for respiratory syncytial virus infection, ranging from 63 for premature infants without chronic lung disease to 12 (confidence interval, 6.3-100.0) for infants with bronchopulmonary dysplasia. A sensitivity analysis of the costs and values of hospital admission for respiratory syncytial virus infection and RSV-IG treatment resulted in a weak recommendation against the treatment of infants with bronchopulmonary dysplasia and strong recommendations that the costs and risks of RSV-IG treatment outweigh the benefits for the combined sample of infants and premature infants without lung disease.

Conclusions  The number-needed-to-treat procedures offer a method to assess evidence of treatment effects and decision rules for whether to accept treatment recommendations. Under plausible assumptions, treatment with RSV-IG is not recommended for infants without lung disease. Institutions can examine cost and benefit assumptions that best fit their own practice setting.

From the Center for Applied Research and Evaluation (Drs Robbins and Tilford and Mr Gillaspy) and the Division of Pediatric Infectious Diseases (Drs Jacobs, Wheeler, and Schutze), Department of Pediatrics, and the Division of Allergy and Immunology (Dr Wheeler), University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock.

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