Cost-effectiveness of rule-based immunoprophylaxis against respiratory syncytial virus infections in preterm infants

Zeitschrift für Kinderheilkunde - Tập 177 Số 1 - Trang 133-144 - 2018
Maarten O Blanken1, Geert Frederix2, Elisabeth E. Nibbelke1, Hendrik Koffijberg3, Elisabeth A. M. Sanders1, Maroeska Rovers4, Louis Bont1
1Division of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, the Netherlands
2Division: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
3Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
4Departments of Epidemiology, Biostatistics and HTA, and Operating Rooms, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands

Tóm tắt

Abstract The objective of the paper is to assess the cost-effectiveness of targeted respiratory syncytial virus (RSV) prophylaxis based on a validated prediction rule with 1-year time horizon in moderately preterm infants compared to no prophylaxis. Data on health care consumption were derived from a randomised clinical trial on wheeze reduction following RSV prophylaxis and a large birth cohort study on risk prediction of RSV hospitalisation. We calculated the incremental cost-effectiveness ratio (ICER) of targeted RSV prophylaxis vs. no prophylaxis per quality-adjusted life year (QALYs) using a societal perspective, including medical and parental costs and effects. Costs and health outcomes were modelled in a decision tree analysis with sensitivity analyses. Targeted RSV prophylaxis in infants with a first-year RSV hospitalisation risk of > 10% resulted in a QALY gain of 0.02 (0.931 vs. 0.929) per patient against additional cost of €472 compared to no prophylaxis (ICER €214,748/QALY). The ICER falls below a threshold of €80,000 per QALY when RSV prophylaxis cost would be lowered from €928 (baseline) to €406 per unit. At a unit cost of €97, RSV prophylaxis would be cost saving. Conclusions: Targeted RSV prophylaxis is not cost-effective in reducing RSV burden of disease in moderately preterm infants, but it can become cost-effective if lower priced biosimilar palivizumab or a vaccine would be available.

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Zeitschrift für Kinderheilkunde

Tập 177 Số 1

133-144

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