RIBAVIRIN THERAPY - IMPLEMENTATION OF HOSPITAL GUIDELINES AND EFFECT ON USAGE AND COST OF THERAPY

Objective. The American Academy of Pediatrics (AAP) recommends that ri bavirin be reserved for infants who are severely ill and who are at hi gh risk of morbidity and mortality, based on underlying clinical condi tions. The purpose of this study was to evaluate current ribavirin use in our institution, implement hospital-specific guidelines for use, d evelop a prospective surveillance system to monitor ribavirin therapy, and evaluate the impact of these guidelines on subsequent use and cos t of therapy. Methods. Ribavirin use was compared with the recommendat ions of the AAP. Results were presented to the professional staff, and hospital guidelines were implemented. Ribavirin therapy was reevaluat ed in a 2-year period after hospital guidelines were implemented. Resu lts. In the initial evaluation period, only 67% of the ribavirin recip ients met the AAP guidelines for use, and 19% received an inappropriat e treatment regimen. The total cost and billed patient charges for rib avirin recipients who did not meet the guidelines for use in period 1 was $60638 and $127940, respectively. Over the next 2 years (period 2) after the implementation of hospital guidelines, the percentage of pa tients who received ribavirin decreased 35%, and approximately 96% of ribavirin recipients met the established criteria. Based on the decrea se in the percentage of patients who received ribavirin in period 2 (4 1% versus 63%), the estimated cost avoidance and reduction in billed p atient charges in period 2 was $55540 and $117334, respectively. This represents an estimated reduction in hospital costs and billed patient charges of $46283 and $97778 per 100 admissions for acute bronchiolit is. Conclusions. Before the implementation of hospital guidelines for use, a substantial percent of patients received ribavirin not consiste nt with the recommendations of the AAP. Following the adoption of a mo dified version of the AAP guidelines for our institution and the use o f a multidisciplinary surveillance system for monitoring ribavirin the rapy, 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.