Cost-effectiveness of rule-based immunoprophylaxis against respiratory syncytial virus infections in preterm infants
Blanken, Maarten O.; Frederix, Geert W.; Nibbelke, Elisabeth E.; Koffijberg, Hendrik; Sanders, Elisabeth A.M.; Rovers, Maroeska; Bont, Louis; on behalf of the Dutch RSV Neonatal Network
(2018) European Journal of Pediatrics, volume 177, issue 1, pp. 133 - 144
(Article)
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
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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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Keywords: Cost-effectiveness analysis, Moderately preterm infants, Prediction rule, Prophylaxis, Respiratory syncytial virus, Pediatrics, Perinatology, and Child Health
ISSN: 0340-6199
Publisher: Springer Verlag
Note: Funding Information: Dekker MA, MD, gathered data and performed the statistical analyses for the Dutch RSV Mortality Study (Supplement); Jansen NJG, MD, supervised data gathering for the Dutch RSV Mortality Study. LB reports consulting fees from Janssen, Gilead, Okairos, Mabxience, Alios and AIT, during the conduct of the study; MOB reports consulting fees from AbbVie. All other authors have indicated they have no potential conflicts of interest to disclose. LB reports grants for investigator-initiated studies from MedImmune and from AbbVie, including the MAKI trial from which data for this cost-effectiveness study were derived. Funding Information: Authors’ Contributions The MAKI trial and RISK study were conceived by LB and MMR. RISK and MAKI were designed by LB and MOB. EEN and MOB collected data for both studies. MOB conceived and wrote the report. MOB conceived and performed the statistical and economic analyses with support for data interpretation from GWF, MMR and HK. EAM, GWF, HK, MMR and LB reviewed the intellectual content and the final report. All authors reviewed and approved the final version of the manuscript submitted for publication.Funding informationThis investigator-driven study was funded by a grant from the Netherlands Organisation for Health Research and Development (NWO-AGIKO grant 920-035-89, to Dr. Blanken). The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. Publisher Copyright: © 2017, The Author(s).
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