Purpose: Palivizumab is a prophylactic therapy shown to reduce the number of respiratory syncytial virus (RSV)-related hospitalizations but has a high acquisition cost. The purpose of this review was to systematically examine the cost-effectiveness of palivizumab in defined infant groups and identify important cost and outcome determinants.
Method: Literature searches of MedLine, the Cost-Effectiveness Analysis (CEA) registry and the UK NHS Economic Evaluation Database (NHS EED) were conducted to identify economic evaluations of palivizumab compared to no prophylactic treatment for RSV prevention in any infant population. Study quality was evaluated using Quality of Health Economic Studies (QHES) criteria and results converted to 2009 CAN$ for comparison.
Result: 23 articles meeting inclusion criteria were identified, including 11 cost-utility analyses (CUAs) assessing cost per quality-adjusted life year (QALY) gained, and 12 cost-effectiveness analyses (CEAs) assessing life-year gained (LYG) or hospital admission prevented (HAP). Quality of individual analyses was fairly high (range 60-100, median 86). Results ranged from cost dominance for prophylaxis to $3,365,769/QALY depending on population, outcome measures, and input parameters. Palivizumab was more cost-effective in studies measuring QALYs. Base case and sensitivity analysis mortality rates varied between studies and influenced results.
Conclusion: RSV prophylaxis with palivizumab is cost-effective in specific groups of high-risk infants, especially those with multiple environmental risk factors. Cost-effectiveness estimates vary between populations and settings and are more positive in those at highest risk for RSV hospitalization.
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