title: Comparison of the cost of hospitalization for respiratory syncytial virus disease versus palivizumab prophylaxis in Canadian Inuit infants.
abstract: BACKGROUND
  The objectives were to compare actual respiratory syncytial virus (RSV) hospitalization rates and costs in a cohort of Inuit infants to hypothetical palivizumab prophylaxis strategies for infants of all gestational ages in the Eastern Canadian Arctic.
  
  
  METHODS
  Incidence and costs of RSV hospitalization were collected for infants admitted to the Baffin Regional Hospital in 2002, before the initiation of palivizumab. There was a comparison of the actual costs to the costs associated with 8 palivizumab strategies stratified by age (<6 months, <1 year) and location (overall, town [Iqaluit], rural communities). It was assumed that each category would receive universal palivizumab prophylaxis resulting in a 78% decrease in RSV admissions. The net costs incurred, number needed to treat (NNT), and incremental costs per hospitalization avoided were calculated for each comparison.
  
  
  RESULTS
  There was a great variation in the rates and costs associated with RSV admissions between Iqaluit and the communities. For infants <1 year of age residing in Iqaluit, the mean admission cost was $3915, and palivizumab prophylaxis had an NNT of 20.4 and cost of $162,551 per admission avoided. For rural infants <6 months, the mean cost of admission was $23,030, and palivizumab prophylaxis resulted in an NNT of 3.9 to 2.5 and cost savings of up to $8118 per admission avoided.
  
  
  CONCLUSIONS
  Due to the high rates and costs associated with RSV admissions, administration of palivizumab in rural communities in the Canadian Arctic to infants less than 6 months of age could result in net cost savings.
authors.affiliation: Department of Pediatrics and Dalla Lana School of Public Health, St. Michael's Hospital, University of Toronto, Toronto, Canada. anna.banerji@utoronto.ca
authors.forename: Anna
authors.initials: A
authors.lastname: Banerji
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lanctôt
authors.forename: Bosco A
authors.initials: BA
authors.lastname: Paes
authors.forename: Shababa T
authors.initials: ST
authors.lastname: Masoud
authors.forename: Derrick Y
authors.initials: DY
authors.lastname: Tam
authors.forename: W Alexander
authors.initials: WA
authors.lastname: Macdonald
authors.forename: Ann
authors.initials: A
authors.lastname: Roberts
mesh_terms: D019072:Antibiotic Prophylaxis / Q000191:economics*; D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use; D002170:Canada; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007223:Infant; D004930:Inuit; D000069455:Palivizumab; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy / Q000191:economics* / Q000208:ethnology / Q000517:prevention & control; D012136:Respiratory Syncytial Viruses / Q000302:isolation & purification*; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000191:economics* / Q000517:prevention & control / Q000821:virology
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents; D000069455:Palivizumab