Optimizing risk factors to guide COST-effective use of palivizumab in KOREAN infants
Ji-Man Kang1,2, Xavier Carbonell-Estrany3, Bosco Paes4
1Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Insights
The International Risk Scoring Tool (IRST) significantly improves respiratory syncytial virus hospitalization (RSVH) prediction and cost-effectiveness in Korean infants compared to current guidelines. This tool offers better protection for vulnerable infants and optimizes prophylaxis targeting.
Area of Science:
- Pediatrics
- Infectious Diseases
- Health Economics
Background:
- Korean infants born at 32-35 weeks gestational age (wGA) are eligible for palivizumab prophylaxis against respiratory syncytial virus hospitalization (RSVH) under specific conditions.
- Current Korean guidelines for prophylaxis targeting are being evaluated for their effectiveness.
Purpose of the Study:
- To assess the impact of implementing the International Risk Scoring Tool (IRST) for palivizumab prophylaxis targeting in Korea.
- To compare the accuracy and cost-effectiveness of the IRST against existing Korean guidelines for preventing RSVH.
Main Methods:
- The IRST, incorporating factors like birth timing relative to RSV season, household smoking, and sibling/daycare contact, was analyzed.
- A historical dataset of 13,475 infants (32-35 wGA) was used to compare the predictive accuracy of Korean guidelines and the IRST for RSVH.
- A cost-utility analysis adapted with Korean parameters evaluated the cost-effectiveness of prophylaxis guided by either method.
Main Results:
- The IRST identified 85.1% of RSVHs with an area under the curve of 0.773, significantly outperforming Korean guidelines (26.9% and 0.512).
- The incremental cost per quality-adjusted life year (QALY) was lower with the IRST (₩26,265,142) compared to Korean guidelines (₩29,674,102).
- The probability of cost-effectiveness at the willingness-to-pay threshold was higher for the IRST (70.8%) than for Korean guidelines (67.0%).
Conclusions:
- Adopting the IRST in Korea enhances protection against RSVH for vulnerable infants born at 32-35 wGA.
- The IRST demonstrates improved cost-effectiveness in targeting palivizumab prophylaxis compared to current Korean guidelines.
Background:
Korean infants born at 32-35 weeks gestational age (wGA) receive palivizumab prophylaxis to prevent respiratory syncytial virus hospitalization (RSVH) if they are born during the RSV season and have a sibling. The aim of this study was to evaluate the impact of using the International Risk Scoring Tool (IRST) to target prophylaxis in Korea.
Methods:
The IRST includes 3 risk factors: birth 3 months before to 2 months after the RSV season starts; smokers in the household and/or smoking while pregnant; and, siblings/daycare. First, the accuracy of the Korean guidelines to predict RSVH was compared to that of the IRST using a historic dataset of 13,475 infants born 32-35 wGA. Second, a published cost-utility model was adapted using Korean-specific parameters for costs (2022) and resource use to assess the cost-effectiveness of palivizumab versus no prophylaxis guided either by the Korean guidelines or the IRST.
Results:
Using the Korean guidelines identified 26.9% of RSVHs, with an area under the receiver operating characteristic curve of 0.512. The corresponding results for infants assessed at moderate- to high-risk by the IRST were 85.1% and 0.773, respectively. The incremental cost per quality-adjusted life year (QALY) for prophylaxis versus no prophylaxis was ₩29,674,102 (USD22,977) using the Korean guidelines, with a 67.0% probability for cost-effectiveness against a willingness-to-pay threshold of ₩41,655,203 (USD32,255). For the IRST, it was ₩26,265,142 (USD20,338)/QALY and 70.8% probability.
Conclusions:
Adoption of the IRST in Korea would provide greater protection of the most vulnerable infants born 32-35 wGA against RSVH whilst improving cost-effectiveness.
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