Updated cost-effectiveness analysis of palivizumab (Synagis) for the prophylaxis of respiratory syncytial virus in infant populations in the UK

Abstract

Aims: Respiratory syncytial virus (RSV) is a common cause of respiratory infection in infants and severe infection can result in hospitalization. The passive immunization, palivizumab, is used as prophylaxis against RSV, however, use in the UK is restricted to populations at high risk of hospitalization. This study assesses the cost-effectiveness (CE) of palivizumab in premature infants with and without risk factors for hospitalization (congenital heart disease [CHD], bronchopulmonary dysplasia [BPD]). Methods: A decision tree model, based on earlier CE analyses, was updated using data derived from targeted literature reviews and advice gained from a Round Table meeting. All costs were updated to 2019 prices. One-way and probabilistic sensitivity analyses were performed to assess the degree of uncertainty surrounding the results. Results: Palivizumab is dominant (i.e. clinically superior and cost saving) when used in premature infants born 35 weeks gestational age (wGA) without CHD or BPD and aged <6 months at the start of the RSV season, infants aged <24 months with CHD and infants aged <24 months requiring treatment for BPD within the last 6 months. Limitations: One-way sensitivity analysis suggests that these results are highly sensitive to the efficacy of prophylaxis, number of doses, impact of long-term respiratory sequalae, rate of hospitalization and mortality due to RSV. A conservative approach has been taken toward long-term respiratory sequalae due to uncertainty around epidemiology and etiology and a lack of recent cost and utility data. Conclusions: Palivizumab prophylaxis is cost-effective in preventing severe RSV infection requiring hospital admission in a wider population than currently recommended in UK guidelines. Prophylaxis in premature infants born <29 wGA, 29-32 wGA and 33-35 wGA without CHD or BPD aged <6 months at the start of the RSV season is not funded under current guidance, however, prophylaxis has been demonstrated to be cost-effective in this analysis.

A new cost-utility analysis assessing risk factor-guided prophylaxis with palivizumab for the prevention of severe respiratory syncytial virus infection in Italian infants born at 29–35 weeks’ gestational age

“…The data utilized in the model were from Greenough et al . 2004 [ 36 ], which are almost two decades old but arguably remain the best available source for utilities following RSVH and are used as the basis of many published cost-effectiveness and cost-utility assessments [ 28 , 45 , 69 ]. Similarly, the estimate of the disutility during RSVH is over 10 years old [ 34 ].…”

“…Assuming an even distribution of births across the year, infant weight at palivizumab administration was modelled using the growth algorithm described by Narayan et al . 2020 [ 45 ]. Based on this approach, the average cost of palivizumab in the base case was estimated to be €2,978 per 29–31wGA infant and €3,422 per 32–35wGA infant.…”

“…Using available data from the Italian Society of Neonatology, average birthweight was estimated to be 1383g and 2203g for 29-31wGA and 32-35wGA infants, respectively [44]. Assuming an even distribution of births across the year, infant weight at palivizumab administration was modelled using the growth algorithm described by Narayan et al 2020 [45]. Based on this approach, the average cost of palivizumab in the base case was estimated to be €2,978 per 29-31wGA infant and €3,422 per 32-35wGA infant.…”

Immunity Cell Responses to RSV and the Role of Antiviral Inhibitors: A Systematic Review

“…76–78 It is a passive immunization used as a prophylaxis. 82 It is provided by once-a-month intramuscular injection during the RSV infection season. It is indicated for prematurely born infants, and children with congenital heart disease to limit hospitalization.…”

Passive Immunoprophylaxis against Respiratory Syncytial Virus in Children: Where Are We Now?

“…Thus, the impact of RSV disease reveals to have short-and long-term consequences and social implications that are difficult to calculate, which are often not included in cost-effectiveness analyses [62,68]. A recent study conducted in the UK showed that palivizumab prophylaxis is cost-effective in preventing severe RSV LRTI in a wider population than currently recommended in guidelines [69]. Narayan et al have found that palivizumab is cost-effective in premature infants born before 35 wGA without CHD or BPD aged <6 months at the start of the RSV season and in premature infants with CHD or BPD aged <2 years, if a mean of 3.7 doses rather than the five doses, is used.…”