Cost-effectiveness Analysis of Palivizumab in Premature Infants Without Chronic Lung Disease

ElHassan, Nahed O.; Sorbero, Melony E.; Hall, Caroline Breese; Stevens, Timothy P.; Dick, Andrew W.

doi:10.1001/archpedi.160.10.1070

Cited by 81 publications

(64 citation statements)

References 51 publications

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“…While these analyses have varied, all have questioned the costeffectiveness of the initial American Academy of Pediatrics recommendations. [18][19][20][21][22][23][24] In many of these analyses, given its high cost, the infants for whom palivizumab was most likely to be costeffective were those with gestational age <29 weeks gestation and/or those with chronic lung disease. While an analysis of the number of doses of palivizumab given from 1998 to 2000 is beyond the scope of this study, the current data suggest that a study of the impact of palivizumab on numbers of hospitalizations of premature infants for RSV infection is warranted.…”

Section: Discussionmentioning

confidence: 99%

Cost, causes and rates of rehospitalization of preterm infants

Danielsen²,

2007

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Objective: To examine hospital readmissions for premature infants during the first year of life.Study Design: The California maternal and newborn/infant hospital discharge records were examined for subsequent readmission during the first year of life for all newborns from 1992 to 2000. Discharge diagnoses, hospital days, demographic data and hospital charges for infants born preterm (<36 weeks gestation) were identified and evaluated.Result: About 15% of preterm infants required at least one rehospitalization within the first year of life (average cost per readmission $8468, average annual cost in excess of $41 million). Infants with gestational age <25 weeks had the highest rate of readmission (31%) and longest average length of stay (12 hospital days). The largest cohort, infants born at 35 weeks gestation, had the highest total cost of readmission ($92.9 million). The most common cause of rehospitalization was acute respiratory disease. There was no decrease in the number or cost of readmissions of premature infants for respiratory syncytial virus infections following the introduction of palivizumab in 1998. Conclusion:After initial discharge, premature infants continue to have significant in-patient health-care needs and costs.

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Section: Discussionmentioning

confidence: 99%

Cost, causes and rates of rehospitalization of preterm infants

Danielsen²,

2007

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“…7 Economic analyses have failed to demonstrate overall savings in health care dollars because of the high cost if all infants who are at risk receive prophylaxis. [8][9][10][11][12][13][14] …”

Section: Cost Considerationsmentioning

confidence: 99%

Modified Recommendations for Use of Palivizumab for Prevention of Respiratory Syncytial Virus Infections

Bocchini¹,

Bernstein²,

Bradley³

et al. 2009

Pediatrics

279

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Palivizumab was licensed in June 1998 by the US Food and Drug Administration for prevention of serious lower respiratory tract disease caused by respiratory syncytial virus (RSV) in pediatric patients who are at increased risk of severe disease. Safety and efficacy have been established for infants born at or before 35 weeks' gestation with or without chronic lung disease of prematurity and for infants and children with hemodynamically significant heart disease. The American Academy of Pediatrics (AAP) published a policy statement on the use of palivizumab in November 1998 (American Academy of Pediatrics, Committee on Infectious Diseases and Committee on Fetus and Newborn. Pediatrics. 1998;102[5]:1211–1216) and revised it in December 2003 (American Academy of Pediatrics, Committee on Infectious Diseases and Committee on Fetus and Newborn. Pediatrics. 2003;112[6 pt 1]:1442–1446), and an AAP technical report on palivizumab was published in 2003 (Meissner HC, Long SS; American Academy of Pediatrics, Committee on Infectious Diseases and Committee on Fetus and Newborn. Pediatrics. 2003;112[6 pt 1]:1447–1452). On the basis of the availability of additional data regarding seasonality of RSV disease as well as the limitations in available data on risk factors for identifying children who are at increased risk of serious RSV lower respiratory tract disease, AAP recommendations for immunoprophylaxis have been updated in an effort to ensure optimal balance of benefit and cost from this expensive intervention. This statement updates and replaces the 2003 AAP statement and the 2006 Red Book and is consistent with the 2009 Red Book recommendations.

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“…Sensitivity analyses show that even with variation in assumptions, the cost of prophylaxis far exceeds a saving from reduced hospitalization rates. 17,20 Future studies may confirm or refute a statistically significant reduction in the number of episodes of recurrent wheezing among recipients of prophylaxis. At that time, the cost savings from fewer episodes of recurrent wheezing among palivizumab recipients may be considered in the complex calculus of a cost analysis of palivizumab prophylaxis.…”

Section: -5mentioning

confidence: 96%

“…15,16 Among independently conducted cost analyses, the cost of prophylaxis with palivizumab is generally found to far exceed the economic benefit of hospital avoidance, even among infants at highest risk. 9,[17][18][19][20] For the highest-risk infants (those born at 23-32 weeks' gestation and who required at least 28 days of supplemental oxygen in the NICU), the number needed to treat to prevent 1 hospitalization in the IMpact-RSV trial was 8.5. 9 For all other infants in the trial, the number needed to treat to prevent 1 RSV hospitalization ranged from 19 to 170.…”

Section: -5mentioning

confidence: 99%

“…However, even when prevention of asthma is included in a cost-effectiveness model, questions about cost and benefit remain. 20 This is because long-term clinical and economic benefits are moderated by the extended time over which the benefit is realized. The critical question will remain: are the statistically significant but modest reductions in hospitalization and wheezing associated with palivizumab prophylaxis of sufficient clinical and societal importance to justify the enormous cost, especially when adverse long-term outcomes such as death are not prevented by passive immunotherapy?…”

Section: -5mentioning

confidence: 99%

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