TY - JOUR
T1 - Cost-effectiveness of rule-based immunoprophylaxis against respiratory syncytial virus infections in preterm infants
AU - on behalf of the Dutch RSV Neonatal Network
AU - Blanken, Maarten O.
AU - Frederix, Geert W.
AU - Nibbelke, Elisabeth E.
AU - Koffijberg, Hendrik
AU - Sanders, Elisabeth A.M.
AU - Rovers, Maroeska M.
AU - Bont, Louis
N1 - Publisher Copyright:
© 2017, The Author(s).
PY - 2018/1/1
Y1 - 2018/1/1
N2 - 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.
AB - 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.
KW - Cost-effectiveness analysis
KW - Moderately preterm infants
KW - Prediction rule
KW - Prophylaxis
KW - Respiratory syncytial virus
UR - http://www.scopus.com/inward/record.url?scp=85034668012&partnerID=8YFLogxK
U2 - 10.1007/s00431-017-3046-1
DO - 10.1007/s00431-017-3046-1
M3 - Article
C2 - 29168012
AN - SCOPUS:85034668012
SN - 0340-6199
VL - 177
SP - 133
EP - 144
JO - European Journal of Pediatrics
JF - European Journal of Pediatrics
IS - 1
ER -