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The cost effectiveness of palivizumab: a systematic review of the evidence
Kelly A Smart1, Krista L Lanctôt, Bosco A Paes
1Medical Outcomes and Research in Economics (MORE®), Sunnybrook Health Sciences Centre and Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.
Insights
Palivizumab prophylaxis for respiratory syncytial virus (RSV) is cost-effective for high-risk infants. Its effectiveness varies by population and setting, with the greatest value seen in infants most vulnerable to RSV hospitalization.
Area of Science:
- Health Economics
- Pediatrics
- Infectious Diseases
Background:
- Palivizumab is a prophylactic therapy for respiratory syncytial virus (RSV).
- It reduces RSV-related hospitalizations but incurs high acquisition costs.
- Systematic examination of its cost-effectiveness in specific infant groups is needed.
Purpose of the Study:
- To systematically review the cost-effectiveness of palivizumab for RSV prevention.
- To identify key cost and outcome determinants for palivizumab therapy.
- To evaluate its economic value in defined infant populations.
Main Methods:
- Conducted literature searches of MedLine, Cost-Effectiveness Analysis registry, and NHS EED.
- Included economic evaluations comparing palivizumab to no prophylaxis in any infant population.
- Assessed study quality using QHES criteria and converted results to 2009 CAN$.
Main Results:
- Identified 23 articles: 11 cost-utility analyses and 12 cost-effectiveness analyses.
- Study quality was generally high (median QHES score 86).
- Cost-effectiveness ranged from cost dominance to $3,365,769/QALY, influenced by population, outcomes, and parameters.
Conclusions:
- Palivizumab prophylaxis is cost-effective in specific high-risk infant groups, particularly those with multiple environmental risk factors.
- Cost-effectiveness estimates vary significantly across populations and settings.
- The economic value is most favorable in infants at the highest risk for RSV hospitalization.
Objective:
Palivizumab is a prophylactic therapy shown to reduce the number of respiratory syncytial virus (RSV)-related hospitalizations but has a high acquisition cost. The objective was to systematically examine the cost effectiveness of palivizumab in defined infant groups and identify important cost and outcome determinants.
Methods:
Literature searches of MedLine, the Cost-Effectiveness Analysis registry and the UK NHS Economic Evaluation Database (NHS EED) were conducted to identify economic evaluations of palivizumab compared to no prophylactic treatment for RSV prevention in any infant population. Study quality was evaluated using Quality of Health Economic Studies (QHES) criteria and results converted to 2009 CAN$ for comparison.
Results:
A total of 23 articles meeting inclusion criteria were identified, including 11 cost-utility analyses (CUAs) and 12 cost-effectiveness analyses (CEAs). Quality of individual analyses was fairly high (range 60-100, median 86). Results ranged from cost dominance for prophylaxis to $3,365,769/QALY depending on population, outcome measures, and input parameters. Base-case and sensitivity-analysis mortality rates varied between studies and influenced results.
Conclusions:
RSV prophylaxis with palivizumab is cost effective in specific groups of high-risk infants, especially those with multiple environmental risk factors. Cost-effectiveness estimates vary between populations and settings and are more positive in those at highest risk for RSV hospitalization.
Limitations:
Direct comparison of the published reports was limited by restriction to English language articles and the varied methodologies, input measures, and populations across the studies reviewed. Although reported currencies were converted to a common unit for comparison, this does not completely account for monetary and inflation differences.
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