Cost-effectiveness of Palivizumab for Respiratory Syncytial Virus: A Systematic Review

Abstract

CONTEXT: Palivizumab prophylaxis is used as passive immunization for respiratory syncytial virus (RSV). However, because of its high cost, the value of this intervention is unclear. OBJECTIVE: To systematically review the cost-effectiveness of palivizumab prophylaxis compared with no prophylaxis in infants <24 months of age. DATA SOURCES: Medline, Embase, and Cochrane Library up to August 2018. STUDY SELECTION: Two reviewers independently screened results to include economic evaluations conducted between 2000 and 2018 from Organization for Economic Cooperation and Development countries. DATA EXTRACTION: Two reviewers independently extracted outcomes. Quality appraisal was completed by using the Joanna Briggs Institute checklist. Costs were adjusted to 2017 US dollars. RESULTS: We identified 28 economic evaluations (20 cost-utility analyses and 8 cost-effectiveness analyses); most were from the United States (n = 6) and Canada (n = 5). Study quality was high; 23 studies met >80% of the Joanna Briggs Institute criteria. Palivizumab prophylaxis ranged from a dominant strategy to having an incremental cost-effectiveness ratio of $2 526 203 per quality-adjusted life-year (QALY) depending on study perspective and targeted population. From the payer perspective, the incremental cost-effectiveness ratio for preterm infants (29–35 weeks’ gestational age) was between $5188 and $791 265 per QALY, with 90% of estimates <$50 000 per QALY. Influential parameters were RSV hospitalization reduction rates, palivizumab cost, and discount rate. LIMITATIONS: Model design heterogeneity, model parameters, and study settings were barriers to definitive conclusions on palivizumab’s economic value. CONCLUSIONS: Palivizumab as RSV prophylaxis was considered cost-effective in prematurely born infants, infants with lung complications, and infants from remote communities.

Current State of Respiratory Syncytial Virus Disease and Management

“…Although some experts believe that cost was an influencing factor for the policy change, the AAP stated that the similar risk of RSVH in > 29 wGA infants and term infants was the rationale for the change [ 23 , 55 ]. While the cost-effectiveness of palivizumab has been debated, many studies have shown that it is efficacious in the pediatric populations for which it is indicated [ 56 ]. Placebo-controlled randomized clinical studies have continually shown that palivizumab effectively reduces the risk of RSVH in 32–35 wGA infants.…”

Predicting Lung Health Trajectories for Survivors of Preterm Birth

“…Palivizumab, a humanized monoclonal antibody used to prevent RSV infections, has shown evidence that it may significantly reduce acute and chronic morbidity following RSV infection in preterm infants (126,127). The use of palivizumab is generally restricted, however, due to the high financial cost of the treatment and uncertainty regarding cost-effectiveness (128,129).…”

Respiratory syncytial virus immunisation overview

“…There is existing evidence supporting the efficacy of monoclonal antibodies in providing passive protection in RSV. Palivizumab, a monoclonal antibody that targets the F‐protein, has a moderate effect in preventing RSV in at risk infants 12 . Its use has been restricted to high‐risk neonates in most jurisdictions by a combination of issues, including the cost, partial efficacy and the need for multiple doses throughout the season to maintain efficacy.…”