Background and Aim RSV is the most common cause of lower respiratory tract infection in young children and may result in hospitalisations, long-term sequelae, such as recurrent wheeze and/or asthma, and possibly death. Palivizumab is a prophylaxis against severe RSV infection and has been shown to reduce RSV-related hospitalisations, and provides a preventative option for high-risk infants. The aim of this study is to demonstrate the cost-effectiveness of RSV prophylaxis compared to no prophylaxis in the following high-risk infants groups: infants with chronic lung disease (CLD) and premature babies (<29, 29–32 and 33–35 weeks gestational age (wGA)).
Methods A decision-tree model was developed to reflect the clinical pathway of infants at high-risk of severe RSV infection. Baseline risk of RSV-hospitalisations and efficacy data were taken from palivizumab clinical trials and published meta-analysis. Cost data were obtained from national databases and published literature using an NHS perspective. The main outcome was presented as the incremental costs per Quality-Adjusted Life-Year (QALY) gained (ICER). The base-case analysis considered a lifetime horizon to capture the impact of long-term morbidity and mortality associated with RSV hospitalisations.
Results Prophylaxis against severe RSV infection resulted in ICERs of £19 168, £18 174 & £1185 per QALY for high-risk infants with, CLD and the premature infant groups, <29 wGA and 29–32 wGA respectively compared to no prophylaxis. All results are below the accepted NICE threshold of £30 000 /QALY thus demonstrating cost-effectiveness. The baseline ICER for the 33–35 wGA subgroup was above this threshold however, sensitivity analysis considering risk-factors in this subgroup showed that an increase in baseline risk of hospitalisation, from 7.2% to 11.24%, led to palivizumab becoming a cost-effective option.
Conclusions Severe RSV infection in high-risk infants represents a significant cause of morbidity and mortality and is associated with a high economic burden. Palivizumab was found to be cost-effective compared to no prophylaxis in the UK in all of the subgroups considered, demonstrating a good use of NHS resources.
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