Parental emotional and time costs predict compliance with respiratory syncytial virus prophylaxis

Ambul Pediatr. Nov-Dec 2002;2(6):444-8. doi: 10.1367/1539-4409(2002)002<0444:peatcp>;2.


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.

Objectives: 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.

Publication types

  • Comparative Study

MeSH terms

  • Antibodies, Monoclonal* / adverse effects
  • Antibodies, Monoclonal, Humanized
  • Antiviral Agents* / adverse effects
  • Arkansas
  • Humans
  • Immunoglobulins, Intravenous* / adverse effects
  • Infant
  • Infant, Newborn
  • Infant, Premature*
  • Least-Squares Analysis
  • Multivariate Analysis
  • Pain / etiology
  • Palivizumab
  • Parents / psychology
  • Patient Compliance*
  • Respiratory Syncytial Virus Infections / prevention & control*
  • Stress, Psychological / etiology
  • Time Factors


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Antiviral Agents
  • Immunoglobulins, Intravenous
  • Palivizumab