Cost-effectiveness of extending palivizumab duration

Infants at high risk of respiratory syncytial virus (RSV) usually only receive palivizumab during the first year of life. While children remain at risk of serious complications from RSV the subsequent year, the costs of passive vaccination with this monoclonal antibody would exceed the costs of RSV-related hospital admission.

Palivizumab, a monoclonal antibody against RSV, is an effective prophylaxis of RSV infection in high-risk infants. It is given once per month intramuscularly during the RSV season. When patients are no longer considered to be at increased risk, for example after the first year of life, they no longer qualify for the vaccination although they are still at risk of getting RSV.

In a retrospective cohort study, investigators evaluated the number of vaccinated children that were admitted to the hospital with RSV during the subsequent winter, to determine whether former high-risk paediatric patients developed significant RSV infection during subsequent years. They then compared the cost of palivizumab with length of hospital stay [1]. Electronic medical records of patients were screened to identify unvaccinated children from October 2016 to March 2018. Qualifying patients from the winters of 2016–2017 and 2017–2018 were compared against the following years.

Over the course of 2 winters, 22 patients were identified as having received palivizumab one year, but not qualifying for the subsequent year. Of these, 4 (18%) were admitted to the hospital with RSV the second year with a median stay of 6.5 days. All patients required non-invasive ventilation. The median payment required for each stay was £1,670 while the median costs of palivizumab treatment for these patients would have been £3,748 per patient.

So, while children remain at high risk of RSV despite no longer qualifying for palivizumab, results showed that costs of palivizumab exceeded that of hospital admission. Although the study is limited by its sample size, it seems that it is not cost-effective to extend the vaccination period.

1. Wilson G, et al. Palivizumab: Is it cost effective to extend the vaccination period for patients at risk of severe respiratory syncytial virus infection? Abstract 2845. ERS 2021, 5–8 September.

 

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Posted on 9 November 2021