Is Selective Use of Palivizumab Appropriate in Premature Infants?
In reference to the article in the May 2003 issue of Managed Care entitled “A Health Care Management Company’s Experience with Palivizumab,” the assertions made by William Silverman, MD, in that article deserve comment. The article indicates that Horizon/Mercy denied palivizumab immunoprophylaxis for 152 infants who qualified for such prophylaxis according to the American Academy of Pediatrics (AAP) guidelines, and for whom the request for coverage was made by the children’s physicians. Dr. Silverman’s post hoc conclusion seems to be that, inasmuch as no respiratory syncytial virus (RSV) hospitalizations occurred among this group of infants, the decision to deny prophylaxis was the “appropriate decision.” Dr. Silverman implies that if a health plan denies a costly but effective preventive intervention deemed reasonably appropriate by both the AAP and the physicians caring for the plan’s patients, then the denial is justified so long as no adverse outcomes occur. Using a similar argumen
