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

on behalf of the Dutch RSV Neonatal Network

Research output: Contribution to journalArticlepeer-review

25 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)133-144
Number of pages12
JournalEuropean Journal of Pediatrics
Issue number1
Publication statusPublished - 1 Jan 2018
Externally publishedYes


  • Cost-effectiveness analysis
  • Moderately preterm infants
  • Prediction rule
  • Prophylaxis
  • Respiratory syncytial virus


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