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Palivizumab for respiratory syncytial virus prophylaxis in high-risk infants: a cost-effectiveness analysis
J H Lofland1, J P O'Connor, M L Chatterton
1Office of Health Policy and Clinical Outcomes, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. jennifer.lofland@mail.tju.edu
Insights
Palivizumab prophylaxis for respiratory syncytial virus (RSV) in high-risk infants is cost-effective, with costs per episode avoided varying by prophylaxis price and RSV incidence. Subgroup analysis showed greater benefit in infants over 32 weeks gestational age.
Area of Science:
- Pediatric Infectious Diseases
- Health Economics
- Pharmacoeconomics
Background:
- Palivizumab, a monoclonal antibody, reduces respiratory syncytial virus (RSV) hospitalizations in preterm infants.
- Cost-effectiveness of palivizumab from a provider's perspective using cost data is not well-established.
Purpose of the Study:
- Determine the cost per RSV infection episode avoided with palivizumab prophylaxis in high-risk infants.
- Identify subgroups of infants who benefit most from prophylactic therapy.
Main Methods:
- A decision-analytic model simulated RSV infection episodes to assess cost-effectiveness from a healthcare system perspective.
- Data were sourced from medical literature and the IMpact-RSV trial, including RSV incidence, healthcare resource use, and costs.
- Sensitivity analyses evaluated the impact of palivizumab cost, hospitalization costs, and healthcare visit frequency; subgroup analysis stratified by gestational age and chronic lung disease severity.
Main Results:
- Cost per RSV episode avoided ranged from $0 to $39,591 (at $2500 palivizumab cost) and $2702 to $79,706 (at $4500 palivizumab cost).
- Model sensitivity was low to changes in emergency department, physician office, and home healthcare visits.
- Infants >= 32 weeks gestational age showed a greater difference in RSV incidence between treatment and control groups.
Conclusions:
- The incremental cost-effectiveness of palivizumab is sensitive to RSV incidence in control infants, average RSV hospitalization costs, and palivizumab's cost.
- Clinicians can use this data, alongside other factors, to assess palivizumab's cost-effectiveness in their specific clinical settings and geographic areas.
Background:
Prophylactic therapy with palivizumab, a humanized monoclonal antibody, has been shown to reduce the number of respiratory syncytial virus (RSV)-related hospitalizations in preterm infants. The cost-effectiveness of this therapy has not been evaluated from the provider's perspective using cost data.
Objectives:
The objectives of this study were to determine the cost per RSV infection episode avoided by using prophylactic palivizumab therapy in a high-risk infant population and to determine whether certain subgroups of infants derived greater benefit from prophylactic therapy.
Methods:
A decision-analytic model simulating an RSV infection episode was developed to evaluate the cost-effectiveness of palivizumab prophylaxis from the perspective of the health care system (provider). Data to populate the model were gathered from the medical literature (identified through a MEDLINE search of studies on the incidence of RSV infection) and the IMpact-RSV clinical trial. Data included incidence of RSV infection and the associated health care resource use and costs. Costs to the provider were determined using a university-affiliated hospital cost-accounting system. Cost-effectiveness ratios were calculated over a range of RSV infection incidence rates in a control population. Sensitivity analyses were performed for the cost of palivizumab therapy, the cost of RSV-related hospitalization, and the number of emergency department, physician office, and home health care visits. For the subgroup analysis, infants were classified by gestational age (<32 and > or = 32 weeks) and stratified by severity of chronic lung disease.
Results:
The cost per additional RSV infection episode avoided ranged from dollars 0 (cost savings) to dollars 39,591 for palivizumab prophylaxis costs of dollars 2500 and from dollars 2702 to dollars 79,706 for palivizumab prophylaxis costs of dollars 4500. The model was insensitive to changes in the number of emergency department, physician office, and home health care visits. The difference in RSV incidence between the treatment and control groups was greater among infants > or = 32 weeks' gestational age than among infants <32 weeks' gestational age. onclusions: The incremental cost-effectiveness of palivizumab compared with no prophylactic therapy was sensitive to changes in the incidence of RSV infection in control infants, the average cost of RSV hospitalization, and the cost of palivizumab. Clinicians may use this information along with additional factors to determine whether palivizumab is cost-effective in their clinical setting and geographic area.