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PEDIATRICS Vol. 104 No. 3 September 1999, pp. 419-427
Received Dec 28, 1998; accepted Apr 26, 1999.
,, 
,, §, and, ¶
From the * Division of Pediatric Hematology/Oncology,
Children's Hospital, and the Dana-Farber Cancer Institute, Boston,
Massachusetts; Division of Research and § Department of Quality and
Utilization, Kaiser Permanente Medical Care Program (Northern
California Region), Oakland, California; Department of Pediatrics,
Kaiser Permanente Medical Care Program, Walnut Creek, California; and
¶ Division of Ambulatory Care and Prevention, Harvard Pilgrim Health
Care, Boston, Massachusetts.
Objectives. To evaluate the costs and benefits of two new agents, respiratory syncytial virus immune globulin (RSVIG) and palivizumab, to prevent respiratory syncytial virus (RSV) infection among premature infants discharged from the neonatal intensive care unit (NICU) before the start of the RSV season.
Method. Decision analysis was used to compare the
projected societal cost-effectiveness of three strategies
RSVIG,
palivizumab, and no prophylaxisamong a hypothetical cohort of
premature infants. Probabilities and costs of hospitalization were
derived from a cohort of 1721 premature infants discharged from six
Kaiser Permanente-Northern California NICUs. Efficacies of prophylaxis
were based on published trials. Costs of prophylaxis were derived from
published sources. Mortality among infants hospitalized for RSV was
assumed to be 1.2%. Future benefits were discounted at 3%.
Results. Palivizumab was both more effective and less
costly than RSVIG. Cost-effectiveness varied widely by subgroup.
Palivizumab appeared most cost-effective for infants whose gestational
age was 
32 weeks, who required 
28 days of oxygen in the NICU, and who were discharged from the NICU from September through
November. In this subgroup, palivizumab was predicted to cost
$12 000 per hospitalization averted (after taking into account savings
from prevention of RSV admissions) or $33 000 per life-year saved, and
the number needed to treat to avoid one hospitalization was estimated
at 7.4. However, for all other subgroups, ratios ranged from $39 000
to $420 000 per hospitalization averted or $110 000 to $1 200 000
per life-year saved, and the number needed to treat extended from 15 to
152. The results were sensitive to varying assumptions about the cost
and efficacy of prophylaxis, as well as the probability of
hospitalization, but were less sensitive to the cost of
hospitalization.
Conclusion. In our model, the cost of prophylaxis against RSV for most subgroups of preterm infants was high relative to the benefits realized. Lower costs might permit the benefits of prophylaxis to be extended to additional groups of preterm infants. Key words: respiratory syncytial virus infections, bronchiolitis, cost-effectiveness analysis, neonatal infections, prematurity, infections, respiratory, intensive care, neonatal, bronchopulmonary dysplasia, chronic lung disease, seasonal variation, prophylaxis, passive immunization.
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