Presentation (CTI)

OBJECTIVES: Respiratory syncytial virus (RSV) is a major cause of severe lower respiratory tract infection and hospitalisation among preterm infants. While palivizumab is clinically effective in preventing severe RSV disease, evidence on its economic value in Ecuador remains limited. This study evaluated the cost-effectiveness of palivizumab prophylaxis in preterm infants within the Ecuadorian healthcare system.
METHODS: A decision tree model compared palivizumab prophylaxis (five-dose regimen) with no prophylaxis in infants born at ≤35 weeks of gestational age and aged ≤6 months. The analysis was conducted from the perspective of a third-party payer over a six-year time horizon. Outcomes included RSV-related hospitalisations, recurrent wheezing episodes, and quality-adjusted life-years (QALYs). Clinical inputs were derived from randomised trials and observational studies, and costs were obtained from official Ecuadorian sources. Costs and outcomes were discounted at 5% annually. Probabilistic sensitivity analyses were performed.
RESULTS: Palivizumab reduced total expected costs from USD 9,243.27 to USD 8,179.42, generating savings of USD 1,063.85 per patient. Expected QALYs increased from 0.2900 with no prophylaxis to 0.5360 with palivizumab, resulting in an incremental gain of 0.2460 QALYs. Palivizumab was more effective and less costly, with a negative incremental cost-effectiveness ratio (-USD 4,324.23 per QALY gained), indicating dominance. Probabilistic sensitivity analysis showed a probability exceeding 90% of cost-effectiveness at willingness-to-pay values near zero and approaching 100% across all relevant thresholds.
CONCLUSIONS: Palivizumab is a dominant and cost-saving strategy for preventing severe RSV disease in preterm infants in Ecuador. By reducing RSV-related hospitalisations and recurrent wheezing, palivizumab improves health outcomes while lowering healthcare costs, supporting its inclusion as a high-value intervention within the Ecuadorian public health system.