Cost-effectiveness of rule-based immunoprophylaxis against respiratory syncytial virus infections in preterm infants

Blanken, Maarten O; Frederix, Geert; Nibbelke, Elisabeth E.; Koffijberg, Hendrik; Sanders, Elisabeth A. M.; Rovers, Maroeska M; Bont, Louis

doi:10.1007/s00431-017-3046-1

Cited by 30 publications

(18 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Blanken et al evaluated the costeffectiveness of targeted prophylaxis (first-year RSVH risk > 10%) in the Netherlands using the MAKI randomized trial, the locally derived validated RISK models for RSVH, Dutch prices, and a 1-year time horizon without discounting. 27 The ICER/QALY for prophylaxis versus nonprophylaxis was €214,748, which was well above the threshold of €80,000 per QALY. The investigators indicated that palivizumab in the late preterm cohort would only be cost-effective if the cost per vial decreased to less than half the current price of €928.…”

mentioning

confidence: 86%

Respiratory Syncytial Virus in Otherwise Healthy Prematurely Born Infants: A Forgotten Majority

Paes

2018

Amer J Perinatol

View full text Add to dashboard Cite

Healthy, premature infants ≤35 weeks' gestational age (wGA) are universally recognized to be at an increased risk of perinatal morbidity and mortality. Serious respiratory syncytial virus (RSV) lower respiratory tract infection imposes an additional burden of illness on these infants following hospitalization. Incurred morbidities relative to term infants include longer lengths of hospital stay, admission to intensive care, and need for oxygen and mechanical ventilation, all of which are associated with increased hospital costs. The highest morbidities are experienced by premature infants who are youngest (<3 months' chronological age) and are of lower gestational age. Short- and long-term follow-up indicates that healthy preterm infants both of lower gestational age and who are late preterm have obstructive lung function at baseline, which is further compromised by RSV-related infection during infancy. There is increasing evidence that childhood exposure to an episode of RSV infection may set the stage for an abnormal respiratory function trajectory, which, in adulthood, leads to chronic obstructive pulmonary disease. Healthy premature infants <32 wGA merit RSV prophylaxis based on existing data, whereas moderate- and high-risk preterm infants 32 to 35 wGA should be selectively and cost-effectively targeted for prophylaxis using validated risk scoring tools and country-specific thresholds for funding.

show abstract

mentioning

confidence: 86%

Respiratory Syncytial Virus in Otherwise Healthy Prematurely Born Infants: A Forgotten Majority

Paes

2018

Amer J Perinatol

View full text Add to dashboard Cite

show abstract

“…The cost-effectiveness of using the multinational RST has not been formally assessed; however, economic evaluations have been undertaken on the use of other RSTs or risk-factor based approaches to targeting prophylaxis in late preterm 33-35 wGA infants [19,67,68]. The Canadian RST, based on data from the PICNIC study [40], included seven variables: small for GA (<10th percentile); male sex; born early during the RSV season (November, December, January); family history without eczema; subject or siblings in daycare; >5 individuals in the home, including the subject; and, >1 smoker in the household [17].…”

Section: How Effective Is Palivizumab Prophylaxis In Late Preterm Infmentioning

confidence: 99%

“…The AUROC was 0.703 and the cut-off score for low-risk was defined as <16 (3.5% RSVH rate) and for high-risk as ≥16 (10.0% RSVH rate) [41]. Assuming all high-risk infants would receive prophylaxis, a decision model analysis produced an ICER of €214,748 per QALY, for moderately preterm infants 32-35 wGA, which was considered not cost-effective at a threshold of €80,000 per QALY [67]. Another analysis on 33-35 wGA infants, using data from the Spanish FLIP-2 study [39], assessed costeffectiveness based on infants having either 2 major risk factors and 2 minor risk factors (group A), 2 major and 1 minor risk factors (B), or 2 major risk factors (C) [68].…”

Section: How Effective Is Palivizumab Prophylaxis In Late Preterm Infmentioning

confidence: 99%

“…An Austrian analysis reported palivizumab prophylaxis to be cost-effective in 33-35 wGA infants at €21,862 per QALY from the healthcare system perspective, when administered to those <3 months of age with risk factors [70]. It is important to note that the Canadian, Spanish and Austrian analyses modeled the effects of long-term respiratory morbidity, using life-time (Canadian and Austrian) and 6-year time horizons (Spanish), while the Dutch study included follow-up to only 1 year of age [19,67,68,70]. This could, in part, account for the differences in cost-effectiveness reported.…”

Section: How Effective Is Palivizumab Prophylaxis In Late Preterm Infmentioning

confidence: 99%

See 1 more Smart Citation

Resolving the Debate on RSV Prophylaxis in Late Preterm Infants

Paes¹,

Rodgers‐Gray²,

Carbonell‐Estrany³

2019

The Burden of Respiratory Syncytial Virus Infection in the Young

View full text Add to dashboard Cite

There is still active debate in the scientific literature about the importance of providing respiratory syncytial virus (RSV) prophylaxis to late preterm infants born at 33-35 weeks' gestational age (wGA). The American Academy of Pediatrics and the Canadian Paediatric Society position statements only advocate for RSV prophylaxis for infants <30 wGA. Several publications prove the contrary, reporting substantial morbidity and even mortality in older GA infants, following RSV infection. Consequently, other Societies, such as from Spain and Italy, have different criteria, and include as candidates 30-32 wGA infants and 33-35 wGA infants with risk factors for severe RSV disease. This chapter will systematically examine the current evidence for RSV prophylaxis in both early and late preterm infants 29-35 wGA and the cost-effectiveness of this strategy with the use of risk scoring tools. The authors will attempt to reconcile the misconception that late preterm infants do not merit RSV prophylaxis and hopefully resolve the long-standing debate that currently exists in many countries worldwide.

show abstract

“…The utility values applied to QALYs calculations were collected from the literature. Baseline utility value for hospitalization was 0.95 (23)(24)(25)(26), whereas a 0.88 utility value was used for PICU, given hospitalization (27,28), 0.59 for hospitalization with acute complications, and 0.5 for PICU with acute complications (29,30). The number of QALYs was calculated as the utility value given to a particular health state multiplied by length of time spent in that state.…”

Section: Utilitiesmentioning

confidence: 99%

The Cost ‑effectiveness of Hypertonic Saline Inhalations for Infant Bronchiolitis

Rodriguez

Acuña‐Cordero

2020

Preprint

View full text Add to dashboard Cite

Background Pharmacological treatment for bronchiolitis is primarily supportive because bronchodilators, steroids, and antibiotics, show little benefit. Clinical studies have suggested that nebulized 3% hypertonic solution is useful for infants with bronchiolitis. This study aims to evaluate the cost-effectiveness of the HS inhalations in infant bronchiolitis in a tropical country Methods Decision tree analysis was used to calculate the expected costs and QALYs. All cost and use of resources were collected directly from medical invoices of 193 patient hospitalized with diagnosis of bronchiolitis in tertiary centers, of Rionegro, Colombia. The utility values applied to QALYs calculations were collected from the literature. The economic analysis was carried out from a societal perspective. Results The model showed that nebulized 3% hypertonic solution, was associated with lower total cost than controls (US $200vs US $240 average cost per patient), and higher QALYs ( 0.92 vs 0.91 average per patient); showing dominance. A position of dominance negates the need to calculate an incremental cost-effectiveness ratio. Conclusion The nebulized 3% hypertonic solution was cost-effective in the inpatient treatment of infant bronchiolitis. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines and should be replicated to validate their results in other tropical countries.

show abstract

Cost-effectiveness of rule-based immunoprophylaxis against respiratory syncytial virus infections in preterm infants

Cited by 30 publications

References 37 publications

Respiratory Syncytial Virus in Otherwise Healthy Prematurely Born Infants: A Forgotten Majority

Respiratory Syncytial Virus in Otherwise Healthy Prematurely Born Infants: A Forgotten Majority

Resolving the Debate on RSV Prophylaxis in Late Preterm Infants

The Cost ‑effectiveness of Hypertonic Saline Inhalations for Infant Bronchiolitis

Contact Info

Product

Resources

About