title: Cost utility of palivizumab prophylaxis among pre-term infants in the United States: a national policy perspective.
abstract: OBJECTIVE
  The cost-effectiveness of palivizumab has previously been reported among certain guideline-eligible, high-risk premature infants in Medicaid. Because guideline authorities base decisions on a national perspective, the economic model of palivizumab was adapted to include all infants, that is, public and privately insured patients (60% of palivizumab use is public, 40% is private).
  
  
  METHODS
  This study examined four groups of premature infants without chronic lung disease of prematurity or congenital heart disease: (1) <32 weeks gestational age (wGA) and ≤ 6 months chronologic age (CA); (2) 32-34 wGA, ≤ 3 months CA, with 2009 American Academy of Pediatrics (AAP) risk factors (RFs); (3) 32-35 wGA, ≤ 6 months CA, with 2006 AAP RFs; and (4) 32-35 wGA, ≤ 6 months CA, with ≤ 1 RF. An average estimate was used between public and private payors for (1) background rates of respiratory syncytial virus hospitalization (RSV-H), (2) direct medical costs associated with RSV-H, and (3) cost of palivizumab. Incremental cost-effectiveness ratios (ICERs) are reported in cost per quality-adjusted life-year (QALY) gained. Sensitivity analyses were performed.
  
  
  RESULTS
  Palivizumab saved costs and improved QALYs among infants <32 wGA. Palivizumab was cost-effective in infants 32-34 wGA with 2009 AAP RFs ($44,774 per QALY) and in infants 32-35 wGA with 2006 AAP RFs ($79,477 per QALY). The ICER for infants 32-35 wGA with ≤ 1 RF was $464,476 per QALY. Influential variables in the sensitivity analysis included background rate of RSV-H and cost and efficacy of palivizumab.
  
  
  CONCLUSIONS
  The results are not generalizable to populations outside of the US. The model did not examine all RFs. The wholesale acquisition cost was used as a payment benchmark; actual price paid by end providers varies.
  
  
  CONCLUSIONS
  From a national policy perspective, palivizumab remained cost-effective for publically and commercially insured, guideline-eligible, high-risk premature infants. Palivizumab was not cost-effective in infants of 32-35 wGA with ≤ 1 RF.
authors.affiliation: MedImmune, LLC, Gaithersburg, MD 20878, USA. mahadeviap@medimmune.com
authors.forename: Parthiv J
authors.initials: PJ
authors.lastname: Mahadevia
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Masaquel
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Polak
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Weiner
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000191:economics* / Q000627:therapeutic use; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006291:Health Policy; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019458:Insurance Coverage; D007348:Insurance, Health; D018803:Models, Economic; D000069455:Palivizumab; D019057:Quality-Adjusted Life Years; D018357:Respiratory Syncytial Virus Infections / Q000191:economics / Q000517:prevention & control; D012680:Sensitivity and Specificity; D014481:United States
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents; D000069455:Palivizumab