Cost-effectiveness of Respiratory Syncytial Virus Prophylaxis in Various Indications

Objectives: To evaluate the cost-effectiveness of immunoprophylaxis against respiratory syncytial virus (RSV) infections with palivizumab based on actual cost and observed incidence rates in various pediatric risk groups. Design: Decision tree analysis comparing children with various combinations of the following indications: chronic lung disease, congenital heart disease, or prematurity (<= 32 weeks gestation), and children with none of these indications. One-way sensitivity analyses and Monte Carlo simulations were used to quantify parameter uncertainty. Setting: Florida during the 2004-2005 RSV season. Participants: A total of 159 790 Medicaid-eligible children aged 0 to 2 years. Intervention: Palivizumab prophylaxis compared with no prophylaxis. Outcomes Measure: Incremental cost (2010 US dollars) per hospitalization for RSV infection avoided. Results: The mean cost of palivizumab per dose ranged from $1661 for infants younger than 6 months of age to $2584 for children in their second year of life. Among pre-term infants younger than 6 months of age without other indications, immunoprophylaxis with palivizumab cost $302 103 (95% confidence interval, $141 850-$914 798) to prevent 1 RSV-related hospitalization. Given a mean cost of $8910 for 1 RSV-related hospitalization in this subgroup, palivizumab would be cost-neutral at a per-dose cost of $47. Incremental cost-effectiveness ratios for the other subgroups ranged from $361 727 to more than $1.3 million per RSV-related hospitalization avoided in children up to 2 years of age with chronic lung disease and no additional risk factors. Younger age and multiple indications were associated with improvements in the incremental cost-effectiveness ratio. Conclusions: The cost of immunoprophylaxis with palivizumab far exceeded the economic benefit of preventing hospitalizations, even in infants at highest risk for RSV infection.