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In 2011, James Bush, MD, Wyoming Medicaid’s medical director with the Wyoming Department of Health, was puzzled why prescriptions of pavilizumab (also known by its brand name, Synagis) had significantly increased in Wyoming during 2010. The injection is an expensive but important tool to prevent respiratory syncytial virus (RSV) lung infections in premature infants and other infants at risk for complications. To reduce hospitalization and death from RSV, the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention recommends that pavilizumab be given to certain high-risk infants in monthly injections during the RSV season, which generally lasts from November through March.
Bush says, “We wanted to know what was going on, so we started pulling reports [of pavilizumab prescribing].” He found that many children who received injections actually didn’t need them. Some providers prescribed the medication outside of RSV season. There were also cases of children receiving the medication who were either over 24 months old or who were not high risk. In addition to the cost involved, these practices unnecessarily exposed children to the pain of injections and the side effects of the medication.
Bush and his colleagues promoted the AAP’s evidence-based pavilizumab guidelines to the state’s Pharmacy and Therapeutics Committee. As part of this process, providers and the general public were invited to comment. The committee voted to follow the national recommendations for dispensing pavilizumab, and Wyoming Medicaid formally adopted them.
A unique characteristic of the Wyoming health care system is that most physicians in the state are able to share patient data through a statewide gateway. Multiple databases are connected in this way, and this aggregation makes a variety of analytical processes possible.
To monitor the effect of the new pavilizumab policy, staff at the Wyoming Department of Health tracked doses of the medication given to infants and hospital admissions due to RSV. Bush says, “The data we had made it possible to look at the incidence of RSV both from a public health standpoint and a clinical standpoint.” The data showed that the policy change decreased unnecessary use of pavilizumab without increasing hospitalizations due to RSV. In all, the change in pavilizumab policy saved Wyoming $1.5 million in the year following its implementation.