Impact of using the International Risk Scoring Tool on the cost-utility of palivizumab for preventing severe respiratory syncytial virus infection in Canadian moderate-to-late preterm infants. (31st December 2023)

• Record Type: Journal Article
• Authors: Rodgers-Gray, Barry S.; Fullarton, John R.; Carbonell-Estrany, Xavier; Keary, Ian P.; Tarride, Jean-Éric; Paes, Bosco A.
• Is Part Of: Journal of medical economics. Volume 26:Number 1(2023)
• Page Start: 630
• Page End: 643
• Publication Date: 2023-12-31
• Subjects: Canada -- cost-effectiveness -- cost-utility -- palivizumab -- respiratory syncytial virus -- RSV; I10 -- I1 -- I -- I18 -- L65 -- L6 -- L; Medical care -- Cost control -- Periodicals; Medical economics -- Periodicals; 362.10941
• DOI: 10.1080/13696998.2023.2202600
• Languages: English
• ISSNs: 1369-6998

Abstract

Abstract: Background and objective: To assess the cost-utility of palivizumab versus no prophylaxis in preventing severe respiratory syncytial virus (RSV) infection in Canadian moderate-to-late preterm (32–35 weeks' gestational age) infants using an (i) International Risk Scoring Tool (IRST) and (ii) Canadian RST (CRST). Methods: A decision tree was developed to assess cost-utility. Infants assessed at moderate- and high-risk of RSV-related hospitalization (RSVH) by the IRST or CRST received palivizumab or no prophylaxis and then progressed to either (i) RSVH; (ii) emergency room/outpatient medically attended RSV-infection (MARI) or (iii) were uninfected/non-medically attended. Infants admitted to intensive care could incur mortality (0.43%). Respiratory morbidity was accounted in all uninfected surviving infants for 6 years or 18 years (RSVH/MARI). Palivizumab efficacy (72.2% RSVH reduction) and hospital outcomes were from the Canadian CARESS, PICNIC and RSV-Quebec studies. Palivizumab costs (50 mg: CAN$752; 100 mg: $1, 505) were calculated from Canadian birth statistics combined with a growth algorithm. Healthcare/payer and societal costs (May 2022; 1.5% discounting) were included. Results: Cost per quality-adjusted life year (QALY) was $29, 789 with the IRST (0.79 probability of being <$50, 000) and $15, 833 with the CRST (0.96 probability). The model was most sensitive to utility scores, long-term sequelae and palivizumab cost. Vial sharing improved the incremental cost-utility ratio (IRST: $22, 319; CRST: $9, 231). Conclusions: Palivizumab was highly cost-effective ( vs no prophylaxis) in Canadian moderate-to-late preterm infants using either the IRST or CRST. The IRST has fewer risk factors than the CRST (3 vs 7, respectively), captures more potential RSVHs (85% vs 54%) and provides another option to guide cost-effective RSV prophylaxis in Canada. Graphical Abstract: UF0001