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Published on: January 12, 2018
Clinical and economic evaluation of risk factor guided respiratory syncytial virus prophylaxis in Colombian preterm
Carlos E Rodriguez-Martinez1, Jaime Ordonez2, Xavier Carbonell-Estrany3
1Department of Pediatrics, Universidad Nacional de Colombia, Bogota, Colombia. carerodriguezmar@unal.edu.co.
Insights
The International Risk Scoring Tool (IRST) effectively targets palivizumab prophylaxis for high-risk infants, proving cost-effective in Colombia. This strategy helps prevent respiratory syncytial virus hospitalizations in premature infants.
Area of Science:
- Pediatric Infectious Diseases
- Health Economics
- Public Health Policy
Background:
- The International Risk Scoring Tool (IRST) identifies infants born at 32-35 weeks' gestational age (wGA) at high risk for respiratory syncytial virus hospitalization (RSVH).
- Palivizumab prophylaxis is a targeted intervention for high-risk infants, but cost-effective targeting is crucial.
- This study evaluates the IRST-guided palivizumab prophylaxis strategy in Colombia for the first time.
Purpose of the Study:
- To evaluate the cost-effectiveness of the IRST-guided palivizumab prophylaxis in Colombian infants born at 32-35 wGA.
- To assess the predictive accuracy of the IRST, adapted for Colombian context, in identifying infants at risk for RSVH.
- To compare the costs and outcomes of IRST-guided palivizumab prophylaxis versus no prophylaxis.
Main Methods:
- The IRST, with gestational age replacing chronological age, was assessed using data from 81 infants with RSVH and 49 matched controls (32-35 wGA).
- A cost-utility analysis was performed from a healthcare provider perspective, using Colombian costs and a 5% discount rate.
- The model considered outcomes including RSVH, medically-attended RSV infection, and potential long-term respiratory morbidity over a lifetime horizon.
Main Results:
- The most predictive risk factor combination included the IRST, mixed breast/formula feeding, and maternal education (AUC = 0.823).
- For moderate- and high-risk infants, the cost per quality-adjusted life year (QALY) was COP20,225,126 (USD4,752).
- Probabilistic sensitivity analyses indicated a 61.1% probability of palivizumab being cost-effective at Colombia's GDP per capita willingness-to-pay threshold.
Conclusions:
- IRST-guided palivizumab prophylaxis for 32-35 wGA infants at moderate- and high-risk of RSVH is cost-effective in Colombia.
- The adapted IRST provides a valuable tool for targeting palivizumab to infants most likely to benefit, optimizing resource allocation.
- This strategy represents an effective public health intervention to reduce the burden of RSVH in premature infants.
Background:
The International Risk Scoring Tool (IRST) comprises three risk factors (age relative to the respiratory syncytial virus [RSV] season; household and/or maternal smoking; siblings and/or daycare attendance) and enables the cost-effective targeting of palivizumab to infants born at 32-35 weeks' gestational age (wGA) at greatest risk of related hospitalization (RSVH). This study provides the first evaluation of IRST-guided RSV prophylaxis in Colombia.
Methods:
The IRST (with wGA substituted for chronological age as RSV is endemic in Colombia) plus other risk factors were assessed using data from 81 infants born 32-35 wGA with RSVH and 49 gestational- and age-matched controls. A cost-utility model comparing IRST-guided palivizumab versus no prophylaxis from the healthcare provider perspective was then adapted using Colombian costs and data (5% discounting). Infants could experience either RSVH, emergency room medically-attended, RSV infection, or remain uninfected/non-attended, with possible long-term respiratory morbidity up to 18 years of age over a lifetime time horizon.
Results:
The most predictive combination of risk factors was the IRST plus mixed breast and formula feeding and maternal education (area under the receiver operating characteristic curve = 0.823). For infants assessed at moderate- and high-risk of RSVH, the cost/quality-adjusted life year (QALY) was COP20,225,126 (USD4,752). Probabilistic sensitivity analyses resulted in a mean of COP22,193,734/QALY (USD5,214/QALY), with a 61.1% probability of palivizumab being cost-effective at a COP28,193,734 (USD6,624; 2022 gross domestic product/capita) willingness-to-pay threshold.
Conclusions:
Palivizumab prophylaxis of 32-35 wGA infants at moderate- and high-risk of RSVH, identified using the Colombian-adapted IRST, proved to be cost-effective versus no intervention.
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