Objective: To assess the cost-effectiveness of palivizumab, a monoclonal antibody against respiratory syncytial virus (RSV), in infants at high risk for severe RSV lower respiratory tract infection, such as premature infants, infants with bronchopulmonary dysplasia, and those with congenital heart disease, based on long-term epidemiologic data from Austria.
Methods: A decision-tree model was used, and the analysis was based on a lifetime follow-up investigating cost-effectiveness of palivizumab versus no RSV infection prevention. The primary perspective of the study was that of the healthcare system, the second that of society. Cost and effects were discounted by 5%. The base case analysis included only direct medical costs, and a scenario analysis included various indirect costs.
Results: Analyses were based on epidemiologic data on a total of 1579 children hospitalized because of RSV lower respiratory tract infection during 16 seasons. The incremental cost-effectiveness ratio for the first outcome measure (life years gained) amounted to discounted costs of €34,956 (for all preterm infants), €35,056 (for <33 weeks' gestational age [wGA] infants), €35,233 (for 33–35 wGA infants), €35,611 (for infants with bronchopulmonary dysplasia), and €8956 (for infants with congenital heart disease). Use of palivizumab compared with no prophylaxis had an incremental cost-utility ratio of €26,212, €26,292, €24,392, €24,654, and €8484, respectively, per quality-adjusted life years. Results from the society perspective were more cost-effective in all study populations. An additional scenario analysis with 7 injections for the 33 to 35 wGA group revealed cost-effectiveness as well.
Conclusions: Our results based on nationwide long-term epidemiologic data suggest that palivizumab is cost-effective in prevention of RSV disease in high-risk infants.
From the *Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria; †Division of Neonatology, Department of Pediatrics, Medical University of Graz, Graz, Austria; ‡Ars Accessus Medica, Amsterdam, The Netherlands; §Abbott Company, Vienna, Austria; and ¶Institute for Pharmacoeconomic Research, Vienna, Austria.
Accepted for publication July 11, 2011.
Conflicts of interest and sources of funding: B.R. has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript including employment, consultancies, stock ownership or options, expert testimony, patents received or pending, or royalties; received honoraria for national and international presentations on the subject of RSV infection and RSV prophylaxis with palivizumab from several Abbott Companies; and conducts and is the principal Investigator of the AIR-NID study (Austrian-Italian multicenter study on RSV infection in neuromuscular disease and immune deficiency syndromes) that is funded by a grant from Abbott Gesellschaft mbH Austria. The authors have no other funding or conflicts of interest to disclose.
Address for correspondence: Bernhard Resch, MD, PhD, Research Unit for Neonatal Infectious Diseases and Epidemiology, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Auenbruggerplatz 30, A-8036 Graz, Austria. E-mail: Bernhard.firstname.lastname@example.org.