Cost-utility analysis of Palivizumab for Respiratory Syncytial Virus infection prophylaxis in preterm infants: update based on the clinical evidence in Spain
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2017
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BMC
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Sanchez-Luna M, Burgos-Pol R, Oyagüez I, Figueras-Aloy J, Sánchez-Solís M, Martinón-Torres F, Carbonell-Estrany X. Cost-utility analysis of Palivizumab for Respiratory Syncytial Virus infection prophylaxis in preterm infants: update based on the clinical evidence in Spain. BMC Infect Dis. 2017 Oct 17;17(1):687. doi: 10.1186/s12879-017-2803-0. PMID: 29041909; PMCID: PMC5645982.
Abstract
Background: This study aimed at estimating the efficiency of palivizumab in the prevention of Respiratory Syncytial
Virus (RSV) infection and its sequelae in preterm infants (32day 1-35day 0weeks of gestational age –wGA-) in Spain.
Methods: A decision-tree model was developed to compare health benefits (Quality Adjusted Life Years-QALYs)
and costs of palivizumab versus a non-prophylaxis strategy over 6 years. A hypothetical cohort of 1,000 preterm infants,
32day 1-35day 0 wGA (4.356 kg average weight) at the beginning of the prophylaxis (15 mg/kg of palivizumab; 3.88 average
number of injections per RSV season) was analysed.
The model considered the most recent evidence from Spanish observational and epidemiological studies on RSV infection:
the FLIP II study provided hospital admission and Intensive Care Unit (ICU) admission rates; in-hospital mortality rate was
drawn from an epidemiological study from 2004 to 2012; recurrent wheezing rates associated to RSV infection from
SPRING study were adjusted by the evidence on the palivizumab effect from clinical trials. Quality of life baseline value,
number of hospitalized infants and the presence of recurrent wheezing over time were granted to estimate QALYs.
National Health Service and societal perspective (included also recurrent wheezing indirect cost) were analysed. Total costs
(€, 2016) included pharmaceutical and administration costs, hospitalization costs and recurrent wheezing management
annual costs. A discount rate of 3.0% was applied annually for both costs and health outcomes.
Results: Over 6 years, the base case analysis showed that palivizumab was associated to an increase of 0.
0731 QALYs compared to non-prophylaxis. Total costs were estimated in €2,110.71 (palivizumab) and €671.68
(non-prophylaxis) from the National Health System (NHS) perspective, resulting in an incremental cost utility
ratio (ICUR) of €19,697.69/QALYs gained (prophylaxis vs non-prophylaxis). Results derived from the risk-factors
population subgroups analysed were in line with the total population results. From the societal perspective,
the incremental cost associated to palivizumab decreased to an €1,253.14 (ICUR = €17,153.16€/QALYs gained
for palivizumab vs non-prophylaxis). One-way and probabilistic sensitivity analyses confirmed the robustness of
the model.
Conclusions: The prophylaxis with palivizumab is efficient for preventing from RSV infections in preterm
infants 32day 1-35day 0 wGA in Spain