Assessment of the Cost Utility of Palivizumab for Preventing Severe Respiratory Syncytial Virus (RSV) Infection in Preterm Infants Born 29-35 Weeks' Gestational Age in the Philippines
Author(s)
Sheryl Del Rosario-Famadico, MD1, Xavier Carbonell-Estrany, MD2, Bosco Paes, MD3, Jean-Eric Tarride, PhD3, Barry Rodgers-Gray, BSc, MSc, PhD4, Ian Keary, PhD4, John Fullarton, PhD4.
1Makati Medical Center, Makati City, Philippines, 2Hospital Clinic, Barcelona, Spain, 3McMaster University, Hamilton, ON, Canada, 4Violicom Medical Limited, Aldermaston, United Kingdom.
1Makati Medical Center, Makati City, Philippines, 2Hospital Clinic, Barcelona, Spain, 3McMaster University, Hamilton, ON, Canada, 4Violicom Medical Limited, Aldermaston, United Kingdom.
OBJECTIVES: To provide the first assessment of the cost-utility of palivizumab in the prevention of severe respiratory syncytial virus (RSV) infection in premature infants born at 29-35 weeks’ gestational age (wGA) in the Philippines.
METHODS: An existing model was adapted to assess the cost-utility of palivizumab versus no prophylaxis from the perspective of the private and state healthcare systems in the Philippines. The model considered RSV-related hospitalisation (RSVH), intensive care unit (ICU) admission and mortality, as well as medically-attended emergency room RSV infection, and long-term respiratory morbidity (LTRM). The base case included all 29-31 and those 32-35wGA infants identified as being at high- or moderate-risk for RSVH by the International Risk Scoring Tool (IRST). A lifetime horizon and 5.33% discounting were applied to costs and utilities. Palivizumab efficacy was derived from the IMpact-RSV study (RSVH relative reduction: 63.3% [29-31wGA]; 82.2% [32-35wGA]) and LTRM rates in children up to age 18-years from publicly available international studies. Direct healthcare costs were derived from local sources where available, or were estimated based on expert input. Palivizumab was costed as per list-price. Results were expressed as mean incremental cost utility ratio (ICUR) calculated using probabilistic analysis (1,000 iterations).
RESULTS: Palivizumab was dominant versus no prophylaxis (less costly and more QALYs gained) from a private healthcare perspective. From the state healthcare system perspective, the mean ICUR was PHP20,219 (€322)/QALY, with a 92.3% probability of being cost-effective at a willingness to pay threshold of 1x the gross domestic product per capita (PHP211,666 [€3,376]). Scenario analysis demonstrated that the use of the IRST improved cost-effectiveness in the 32-35wGA subgroup (PHP51,249[€816]/QALY vs PHP116,846 [€1,861]/QALY when IRST not used).
CONCLUSIONS: Palivizumab was found to be cost-effective (vs no prophylaxis) for use in Filipino 29-35wGA infants. The IRST should be considered to target prophylaxis in 32-35wGA infants.
METHODS: An existing model was adapted to assess the cost-utility of palivizumab versus no prophylaxis from the perspective of the private and state healthcare systems in the Philippines. The model considered RSV-related hospitalisation (RSVH), intensive care unit (ICU) admission and mortality, as well as medically-attended emergency room RSV infection, and long-term respiratory morbidity (LTRM). The base case included all 29-31 and those 32-35wGA infants identified as being at high- or moderate-risk for RSVH by the International Risk Scoring Tool (IRST). A lifetime horizon and 5.33% discounting were applied to costs and utilities. Palivizumab efficacy was derived from the IMpact-RSV study (RSVH relative reduction: 63.3% [29-31wGA]; 82.2% [32-35wGA]) and LTRM rates in children up to age 18-years from publicly available international studies. Direct healthcare costs were derived from local sources where available, or were estimated based on expert input. Palivizumab was costed as per list-price. Results were expressed as mean incremental cost utility ratio (ICUR) calculated using probabilistic analysis (1,000 iterations).
RESULTS: Palivizumab was dominant versus no prophylaxis (less costly and more QALYs gained) from a private healthcare perspective. From the state healthcare system perspective, the mean ICUR was PHP20,219 (€322)/QALY, with a 92.3% probability of being cost-effective at a willingness to pay threshold of 1x the gross domestic product per capita (PHP211,666 [€3,376]). Scenario analysis demonstrated that the use of the IRST improved cost-effectiveness in the 32-35wGA subgroup (PHP51,249[€816]/QALY vs PHP116,846 [€1,861]/QALY when IRST not used).
CONCLUSIONS: Palivizumab was found to be cost-effective (vs no prophylaxis) for use in Filipino 29-35wGA infants. The IRST should be considered to target prophylaxis in 32-35wGA infants.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE68
Topic
Economic Evaluation, Health Policy & Regulatory, Health Technology Assessment
Disease
Infectious Disease (non-vaccine), No Additional Disease & Conditions/Specialized Treatment Areas, Pediatrics, Vaccines