OBJECTIVES: Respiratory Syncytial Virus (RSV) is the most common cause of lower respiratory tract infections in infants and young children worldwide. Palivizumab is a humanized murine monoclonal antibody administered monthly as an intramuscular injection and significantly reduces the overall hospitalization rate due to RSV. This study evaluated the cost-utility ratio of palivizumab to prevent RSV in the Dominican Republic.

METHODS: A decision tree was developed in which patients were likely to be infected with RSV, hospitalized, and relapse or develop recurrent wheezing. The comparators are five doses of palivizumab (400 mg in total) vs. no use. Outcomes are hospitalizations avoided for relapses of SVR infections and the rate of children with recurrent wheezing avoided. The model time horizon is six years. Healthcare costs for this population are from a cost analysis of children with RSV in Latin America. In addition, we performed a heterogeneity analysis for preterm infants, children with bronchopulmonary dysplasia (BPD), and children with congenital heart disease (CHD). The Willingness-to-Pay (WTP) threshold used was three times the gross domestic product per capita in the Dominican Republic (USD 21,805).

RESULTS: Palivizumab's complete treatment cost $5,800. Health events caused by SVR (hospitalizations and recurrent wheezing) cost $11,580 in preterm infants who did not receive palivizumab and $5,774 in those who did receive it. Total costs are $8,481 in BPD infants without palivizumab, $5,774 in those with palivizumab, $12,617 in CHD infants without palivizumab, and $8,280 in those with it. Palivizumab is a cost-saving treatment for all populations. Based on the WTP of $21,805, palivizumab has a 71% probability of being the best treatment option to prevent RSV infection in preterm infants, 56% in infants with DBP, and 58% in infants with CHD in the Dominican Republic.

CONCLUSIONS: Palivizumab is a cost-saving strategy to prevent SVR infections in neonates in the Dominican Republic.