Abstract
BackgroundPassive immunization against RSV (Respiratory Syncytial Virus) is given in most western countries (including Israel) to infants of high risk groups such as premature babies, and infants with Congenital Heart Disease or Congenital Lung Disease. However, immunoprophylaxis costs are extremely high ($2800–$4200 per infant). Using cost-utility analysis criteria, we evaluate whether it is justified to expand, continue or restrict nationwide immunoprophylaxis using palivizumab of high risk infants against RSV.MethodsEpidemiological, demographic, health service utilisation and economic data were integrated from primary (National Hospitalization Data, etc.) and secondary data sources (ie: from published articles) into a spread-sheet to calculate the cost per averted disability-adjusted life year (DALY) of vaccinating various infant risk groups. Costs of intervention included antibody plus administration costs. Treatment savings and DALYs averted were estimated from applying vaccine efficacy data to relative risks of being hospitalised and treated for RSV, including possible long-term sequelae like asthma and wheezing.ResultsFor all the groups RSV immunoprophylaxis is clearly not cost effective as its cost per averted DALY exceeds the $105,986 guideline representing thrice the per capita Gross Domestic Product. Vaccine price would have to fall by 48.1% in order to justify vaccinating Congenital Heart Disease or Congenital Lung Disease risk groups respectively on pure cost-effectiveness grounds. For premature babies of < 29 weeks, 29–32 and 33–36 weeks gestation, decreases of 36.8%, 54.5% and 83.3% respectively in vaccine price are required.ConclusionsBased solely on cost-utility analysis, at current price levels it is difficult to justify the current indications for passive vaccination with Palivizumab against RSV. However, if the manufacturers would reduce the price by 54.5% then it would be cost-effective to vaccinate the Congenital Heart Disease or Congenital Lung Disease risk groups as well as premature babies born before the 33rd week of gestation.
Highlights
Passive immunization against Respiratory syncytial virus (RSV) (Respiratory Syncytial Virus) is given in most western countries to infants of high risk groups such as premature babies, and infants with Congenital Heart Disease or Congenital Lung Disease
For all the risk groups and hospitalization ranges, even when the long-term effects of Asthma are included, passive immunization against RSV is clearly not cost effective as its cost per disability-adjusted life year (DALY) is well in excess of the $105,986 guideline (Table 2)
Of particular interest is the 29-32 Gestational Age in Weeks (GAW) infants as the Academy of Pediatrics (AAP) does not recommend providing immunoprophylaxis to this age group. For this group the cost per DALY ratio is around ten times the GNP per capita level in Israel, meaning that giving pulmizamub to this group is clearly not justified on grounds of cost effectiveness, all the more so on those with 33-36 GAW (Table 2)
Summary
Passive immunization against RSV (Respiratory Syncytial Virus) is given in most western countries (including Israel) to infants of high risk groups such as premature babies, and infants with Congenital Heart Disease or Congenital Lung Disease. Using cost-utility analysis criteria, we evaluate whether it is justified to expand, continue or restrict nationwide immunoprophylaxis using palivizumab of high risk infants against RSV. Since the disease course in high risk children is much more severe, and since no active vaccine is available, passive immunization with five sequential monthly injections of anti-RSV monoclonal antibodies (Palivizumab) is given during the RSV season (November – March). This schedule has proven to decrease hospitalization in high risk groups [3]
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