title: Economic evaluation of palivizumab in children with congenital heart disease: a Canadian perspective.
abstract: BACKGROUND
  Respiratory syncytial virus (RSV) is a common cause of bronchiolitis in infants. In children with congenital heart disease (CHD), it is associated with significant morbidity and mortality. Palivizumab is a monoclonal antibody that reduces the number of RSV-associated hospitalizations in children with CHD. We sought to assess cost savings and cost-effectiveness of palivizumab in children < 2 years old with hemodynamically significant CHD in a provincially administered RSV prophylaxis program.
  
  
  METHODS
  A cohort of children who received palivizumab (N = 292) from 2003-2007 was compared to a historical cohort of children (N = 412) from 1998-2003 who met the eligibility criteria for palivizumab prior to initiation of the prophylaxis program. Direct and indirect costs and benefits were determined.
  
  
  RESULTS
  The direct and indirect costs in the historical cohort were $838 per patient season compared to $9130 per patient season in the palivizumab cohort. Risk of admission was reduced by 42%, and days in hospital were reduced by 83%. The incremental cost of the RSV prophylaxis program was $8292 per patient for 1 RSV season. The incremental cost to prevent 1 day of hospitalization was $15,514. The cost of palivizumab accounted for 87.9% of the cost of prophylaxis.
  
  
  CONCLUSIONS
  Palivizumab is clinically effective; however, the cost was exceptionally high relative to the outcomes in this population. Given the financial constraints in a public health care setting, more strict criteria for patient selection or reduced drug costs would improve the cost-effectiveness of RSV prophylaxis.
authors.affiliation: Children's Heart Centre, Division of Cardiology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada. kharris2@cw.bc.ca
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Harris
authors.forename: Aslam H
authors.initials: AH
authors.lastname: Anis
authors.forename: Marsha C
authors.initials: MC
authors.lastname: Crosby
authors.forename: Laurie M
authors.initials: LM
authors.lastname: Cender
authors.forename: James E
authors.initials: JE
authors.lastname: Potts
authors.forename: Derek G
authors.initials: DG
authors.lastname: Human
mesh_terms: D000911:Antibodies, Monoclonal / Q000191:economics* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D001955:British Columbia; D001988:Bronchiolitis / Q000517:prevention & control* / Q000821:virology; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D006330:Heart Defects, Congenital / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D000069455:Palivizumab; D018357:Respiratory Syncytial Virus Infections / Q000517:prevention & control* / Q000821:virology
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000069455:Palivizumab