title: The cost effectiveness of palivizumab in term Inuit infants in the Eastern Canadian Arctic.
abstract: BACKGROUND
  Canadian, Inuit, full term infants have the highest rate of respiratory syncytial virus (RSV) infection globally, which results in substantial costs associated hospitalisation.
  
  
  METHODS
  Decision-analytical techniques were used to estimate the incremental cost-effectiveness ratio (ICER) for palivizumab compared to no prophylaxis for Inuit infants of all gestational age. The time horizon was that of life-time follow-up, and costs and effectiveness were discounted at 5% per year. Costs (2007 CAD$) for palivizumab, hospitalisation (including medical evacuation, intensive care unit [ICU]), physician visits, and transportation were calculated based on the Canadian payer's perspective. Benefits on decreasing RSV hospitalisation were expressed as quality-adjusted life-years (QALYs). One-way and probabilistic sensitivity analysis (PSA) were conducted, varying: mortality rates, utilities, length of stay in hospital and ICU.
  
  
  RESULTS
  For all of Baffin Island infants (<1 year), the ICER was $39,435/QALY. However, when infants were grouped by age and area of residence, those residing in Iqaluit (<1 year) had an ICER of $152,145/QALY, while those residing in rural areas (outside of Iqaluit) had an ICER of $24,750/QALY. Prophylaxis was a dominant strategy (cost saving) for rural infants under 6 months of age, with the PSA demonstrating that it was dominant 98% of the time.
  
  
  CONCLUSIONS
  The ICERs suggested that palivizumab is a cost-effective option for the prevention of RSV for Inuit infants on Baffin Island compared to no prophylaxis. Palivizumab is highly cost effective in Arctic infants <1 year of age specifically residing outside of Iqaluit and is a dominant strategy for those under 6 months of age in rural areas. However, palivizumab is not cost effective compared to no treatment for infants of all ages residing in Iqaluit.
authors.affiliation: Medical Outcomes and Research in Economics Group, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada.
authors.forename: Derrick Y
authors.initials: DY
authors.lastname: Tam
authors.forename: Anna
authors.initials: A
authors.lastname: Banerji
authors.forename: Bosco A
authors.initials: BA
authors.lastname: Paes
authors.forename: Charles
authors.initials: C
authors.lastname: Hui
authors.forename: Jean-Eric
authors.initials: JE
authors.lastname: Tarride
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lanctôt
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000191:economics*; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000191:economics*; D002170:Canada / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007223:Infant; D004930:Inuit / Q000706:statistics & numerical data*; D008297:Male; D020957:Nunavut / Q000453:epidemiology; D000069455:Palivizumab; D019057:Quality-Adjusted Life Years; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy* / Q000191:economics* / Q000208:ethnology / Q000517:prevention & control
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents; D000069455:Palivizumab