title: Cost-effectiveness of palivizumab for respiratory syncytial virus infection in high-risk children, based on long-term epidemiologic data from Austria.
abstract: OBJECTIVE
  To assess the cost-effectiveness of palivizumab, a monoclonal antibody against respiratory syncytial virus (RSV), in infants at high risk for severe RSV lower respiratory tract infection, such as premature infants, infants with bronchopulmonary dysplasia, and those with congenital heart disease, based on long-term epidemiologic data from Austria.
  
  
  METHODS
  A decision-tree model was used, and the analysis was based on a lifetime follow-up investigating cost-effectiveness of palivizumab versus no RSV infection prevention. The primary perspective of the study was that of the healthcare system, the second that of society. Cost and effects were discounted by 5%. The base case analysis included only direct medical costs, and a scenario analysis included various indirect costs.
  
  
  RESULTS
  Analyses were based on epidemiologic data on a total of 1579 children hospitalized because of RSV lower respiratory tract infection during 16 seasons. The incremental cost-effectiveness ratio for the first outcome measure (life years gained) amounted to discounted costs of €34,956 (for all preterm infants), €35,056 (for < 33 weeks' gestational age [wGA] infants), €35,233 (for 33-35 wGA infants), €35,611 (for infants with bronchopulmonary dysplasia), and €8956 (for infants with congenital heart disease). Use of palivizumab compared with no prophylaxis had an incremental cost-utility ratio of €26,212, €26,292, €24,392, €24,654, and €8484, respectively, per quality-adjusted life years. Results from the society perspective were more cost-effective in all study populations. An additional scenario analysis with 7 injections for the 33 to 35 wGA group revealed cost-effectiveness as well.
  
  
  CONCLUSIONS
  Our results based on nationwide long-term epidemiologic data suggest that palivizumab is cost-effective in prevention of RSV disease in high-risk infants.
authors.affiliation: Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Resch
authors.forename: Constanze
authors.initials: C
authors.lastname: Sommer
authors.forename: Mark J C
authors.initials: MJ
authors.lastname: Nuijten
authors.forename: Susanne
authors.initials: S
authors.lastname: Seidinger
authors.forename: Evelyn
authors.initials: E
authors.lastname: Walter
authors.forename: Vera
authors.initials: V
authors.lastname: Schoellbauer
authors.forename: Wilhelm D
authors.initials: WD
authors.lastname: Mueller
mesh_terms: D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000191:economics* / Q000627:therapeutic use; D001317:Austria / Q000453:epidemiology; D018890:Chemoprevention; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control / Q000821:virology; D008297:Male; D000069455:Palivizumab; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control; D012136:Respiratory Syncytial Viruses / Q000187:drug effects*; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control / Q000821:virology; D012306:Risk; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000069455:Palivizumab