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

Maarten O Blanken,On Behalf Of The Dutch Rsv Neonatal Network ,Maroeska M Rovers,Elisabeth A M Sanders,Louis Bont,Hendrik Koffijberg,Elisabeth E Nibbelke,Geert W Frederix

doi:10.1007/s00431-017-3046-1

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.

Highlights

Respiratory syncytial virus (RSV) bronchiolitis is a major cause of infant morbidity in both high income and low- and middle-income countries and is associated with a large burden of disease and high costs [15, 20, 30, 37]
Our results show that targeted RSV prophylaxis is not cost-effective, but it can become cost-effective if a biosimilar palivizumab becomes available at 40% of the cost of current RSV prophylaxis
In moderately preterm infants born at 32–35 weeks gestational age (WGA), we recently reported that about 9% of infants require mechanical ventilation at a paediatric intensive care unit (PICU) [25]

Summary

Introduction

Respiratory syncytial virus (RSV) bronchiolitis is a major cause of infant morbidity in both high income and low- and middle-income countries and is associated with a large burden of disease and high costs [15, 20, 30, 37]. About 28,000 infants require medical care for RSV bronchiolitis in the Netherlands [21, 28], of which approximately 2000 require hospitalisation with costs of €2000–€4000 per patient [9, 23, 33]. RSV prophylaxis has shown to be effective in preventing RSV infection in preterm infants < 35 WGA [8, 39]. The burden of disease is considerable, RSVassociated mortality in healthy term infants is probably low, but published estimates vary between 0 and 8% [15, 30, 31, 34, 36, 38]

Objectives

Methods

Results

Conclusion