title: Economic evaluation of possible prevention of RSV-related hospitalizations in premature infants in Germany.
abstract: Palivizumab (Synagis, MedImmune Inc./Abbott Laboratories) has been shown to reduce the number of respiratory syncytial virus (RSV)-related hospitalizations in premature infants. The cost-effectiveness ratio of this prophylaxis, however, has not been evaluated in the German health-care system to date. The aim of the study was to assess the costs and benefits of Palivizumab among premature infants </=35 weeks with different risk factors. Projecting a societal perspective, we used decision analysis to compare the strategies of a prophylaxis with and without Palivizumab. Probabilities and costs of hospitalization were derived from a retrospective, population-based cohort study on 1,103 prematurely born infants primarily admitted to nine neonatologic care units in southern Germany between November 1998 and October 1999. Costs of prophylaxis were based on hospital sources. Efficacy of prophylaxis and estimates of RSV mortality were derived from the literature. Effectiveness was defined as the number of averted hospitalizations. The cost-effectiveness ratio of Palivizumab varied strongly among the different risk groups. While demonstrating no net cost savings related to RSV prophylaxis for any of the risk groups analyzed, Palivizumab showed the best cost-effectiveness ratio among male infants with chronic lung disease, discharge from primary neonatal care between October and December, and the presence of siblings visiting a day-care group. One averted hospitalization in this high-risk group was associated with costs of Euro 6,639 (number needed to treat (NNT): 4). For infants in other risk groups, the ratios varied from Euro 25,288 (NNT: 8) to Euro 204,684 (NNT: 54) per hospitalization averted. The cost-effectiveness ratios were sensitive to varying assumptions about probabilities and costs of rehospitalization, efficacy, and costs of Palivizumab prophylaxis.
  
  
  CONCLUSIONS
  The results of this cost-effectiveness analysis do not justify the widespread use of Palivizumab among preterm infants. Lowering the costs of prophylaxis would be the most direct way to improve the cost-effectiveness ratio of Palivizumab.
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 München, Germany.
authors.forename: Irmgard
authors.initials: I
authors.lastname: Roeckl-Wiedmann
authors.forename: Johannes G
authors.initials: JG
authors.lastname: Liese
authors.forename: Eva
authors.initials: E
authors.lastname: Grill
authors.forename: Birgit
authors.initials: B
authors.lastname: Fischer
authors.forename: David
authors.initials: D
authors.lastname: Carr
authors.forename: Bernd H
authors.initials: BH
authors.lastname: Belohradsky
mesh_terms: D000911:Antibodies, Monoclonal / Q000191:economics* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D002656:Child Day Care Centers; D002908:Chronic Disease; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D005858:Germany; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000191:economics / Q000517:prevention & control*; D016015:Logistic Models; D008171:Lung Diseases / Q000188:drug therapy / Q000191:economics; D008297:Male; D017059:Models, Econometric; D000069455:Palivizumab; D018357:Respiratory Syncytial Virus Infections / Q000191:economics / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D035781:Siblings
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents; D000069455:Palivizumab