title: The Economics of Strategies to Reduce Respiratory Syncytial Virus Hospitalizations in Alaska.
abstract: BACKGROUND
  Alaska Native infants experience high rates of respiratory syncytial virus (RSV) hospitalizations. Through 2008, Alaska administered a 7-dose (maximum) palivizumab regime to high-risk infants from October to May. In 2009, the maximum was reduced to 3 doses for 32- to 34-week preterm babies and 6 doses for other groups.
  
  
  METHODS
  We used 11 years of data and regional Medicaid reimbursement rates to model the cost effectiveness of 4 palivizumab intervention strategies to reduce RSV hospitalizations among Alaskan infants including: current strategy, old strategy (1998-2008), and 2 hypothetical strategies using the current strategy plus 1 or 3 doses to all newborn infants during the RSV season.
  
  
  RESULTS
  The current strategy represents 5 hospitalizations averted per year for the palivizumab cohort (∼50-56 children) at ∼$52 846 per hospitalization averted, compared with no intervention. Compared with the old strategy, the mean cost per hospitalization prevented for the current strategy was 63% lower, net program costs were 85% lower, and the mean hospitalizations prevented were 27% lower. Compared with current strategy only, the addition of 1 dose to all newborns during the RSV season could decrease the mean cost per hospitalization prevented by 23%, increase the number of hospitalizations prevented by 2.5-fold, and increase the net programmatic costs by 3.3-fold; administering up to 3 doses to infants further reduced hospitalizations and increased costs.
  
  
  CONCLUSIONS
  The current palivizumab strategy improved the cost-effectiveness ratio compared with the old strategy. Further improvement could be obtained by adding doses for Alaskan Native newborns during the RSV season; however, programmatic costs would increase.
authors.affiliation: Division of Preparedness and Emerging Infections.
authors.forename: Rebekah H
authors.initials: RH
authors.lastname: Borse
authors.affiliation: Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases.
authors.forename: Rosalyn J
authors.initials: RJ
authors.lastname: Singleton
authors.affiliation: Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases.
authors.forename: Dana T
authors.initials: DT
authors.lastname: Bruden
authors.affiliation: Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Fry
authors.affiliation: Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Hennessy
authors.affiliation: Division of Preparedness and Emerging Infections.
authors.forename: Martin I
authors.initials: MI
authors.lastname: Meltzer
keywords: Alaska; Synagis; YKD; cost benefit; cost effectiveness; decision making; economics; healthcare costs; infants; palivizumab; respiratory syncytial virus