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Cost-effectiveness of respiratory syncytial virus prophylaxis among preterm infants
S Joffe1, G T Ray, G J Escobar
1Division of Pediatric Hematology/Oncology, Children's Hospital, and the Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
Insights
Palivizumab is more effective and less costly than RSVIG for preventing respiratory syncytial virus (RSV) in premature infants. However, the high cost of prophylaxis limits its widespread benefit across most infant subgroups.
Area of Science:
- Pediatric Infectious Diseases
- Health Economics
- Neonatal Care
Background:
- Respiratory syncytial virus (RSV) poses a significant risk to premature infants.
- Preventive strategies like RSVIG and palivizumab aim to reduce RSV-related hospitalizations.
- Evaluating the cost-effectiveness of these interventions is crucial for resource allocation.
Purpose of the Study:
- To compare the cost-effectiveness of RSVIG, palivizumab, and no prophylaxis for preventing RSV in preterm infants.
- To identify subgroups of premature infants for whom prophylaxis is most beneficial.
Main Methods:
- Decision analysis modeling was used to compare three prophylactic strategies.
- Data on hospitalization costs and probabilities were derived from a cohort of 1721 premature infants.
- Efficacy and cost data for RSVIG and palivizumab were based on published trials and sources.
Main Results:
- Palivizumab demonstrated superior effectiveness and lower costs compared to RSVIG.
- Cost-effectiveness varied significantly by infant subgroup, with palivizumab being most beneficial for infants with gestational age ≤32 weeks requiring prolonged oxygen.
- For most subgroups, the cost per hospitalization averted or life-year saved was substantial.
Conclusions:
- The cost of RSV prophylaxis is high relative to the realized benefits for the majority of preterm infant subgroups.
- Reducing prophylaxis costs could potentially expand its benefits to a wider range of preterm infants.
Objectives:
To evaluate the costs and benefits of two new agents, respiratory syncytial virus immune globulin (RSVIG) and palivizumab, to prevent respiratory syncytial virus (RSV) infection among premature infants discharged from the neonatal intensive care unit (NICU) before the start of the RSV season. Method. Decision analysis was used to compare the projected societal cost-effectiveness of three strategies-RSVIG, palivizumab, and no prophylaxis-among a hypothetical cohort of premature infants. Probabilities and costs of hospitalization were derived from a cohort of 1721 premature infants discharged from six Kaiser Permanente-Northern California NICUs. Efficacies of prophylaxis were based on published trials. Costs of prophylaxis were derived from published sources. Mortality among infants hospitalized for RSV was assumed to be 1.2%. Future benefits were discounted at 3%.
Results:
Palivizumab was both more effective and less costly than RSVIG. Cost-effectiveness varied widely by subgroup. Palivizumab appeared most cost-effective for infants whose gestational age was /=28 days of oxygen in the NICU, and who were discharged from the NICU from September through November. In this subgroup, palivizumab was predicted to cost $12,000 per hospitalization averted (after taking into account savings from prevention of RSV admissions) or $33,000 per life-year saved, and the number needed to treat to avoid one hospitalization was estimated at 7.4. However, for all other subgroups, ratios ranged from $39,000 to $420,000 per hospitalization averted or $110,000 to $1,200,000 per life-year saved, and the number needed to treat extended from 15 to 152. The results were sensitive to varying assumptions about the cost and efficacy of prophylaxis, as well as the probability of hospitalization, but were less sensitive to the cost of hospitalization.
Conclusion:
In our model, the cost of prophylaxis against RSV for most subgroups of preterm infants was high relative to the benefits realized. Lower costs might permit the benefits of prophylaxis to be extended to additional groups of preterm infants.