La eficiencia (coste-efectividad) de palivizumab como profilaxis para la infección por virus respiratorio sincitial en prematuros de 32-35 semanas en España

Identifier:  imarina:6083041

Handle: https://hdl.handle.net/20.500.11797/imarina6083041

Authors:  Lázaro Y De Mercado P; Figueras Aloy J; Doménech Martínez E; Echániz Urcelay I; Closa Monasterolo R; Wood Wood M; Fitch Warner K

Abstract:
Objectives: To evaluate the efficiency (cost-effectiveness) of palivizumab in preventing severe respiratory syncytial virus (RSV) infection in premature infants with a gestational age of 32-35 weeks (GA 32-35) and two or more risk factors (RF) in Spain. Methods: Design: decision tree model using data from the scientific literature and the FLIP I and FLIP II studies (cohort of 326 infants with GA 32-35 and two or more RF who received palivizumab) sponsored by the Spanish Society of Neonatology. Main effectiveness measure: quality-adjusted life years (QALY) gained. Perspectives: the national health service (NHS), which includes direct costs (administration of palivizumab and hospital admissions), and the societal perspective, which also includes indirect costs (the child's future lost productivity). Discount: 3 % annually for effectiveness and indirect costs. Sensitivity analysis: construction of 37 scenarios modifying variables related to effectiveness and costs. Results: Prophylaxis with palivizumab in premature infants with GA 32-35 and two or more RF produced an incremental cost-effectiveness ratio (ICER) of 13,849 €/QALY from the NHS perspective, and an ICER of 4,605 €/QALY from the societal perspective. In the sensitivity analysis, from the NHS perspective the ICER ranged from 5,351 €/QALY (most favorable scenario) to 23,276 €/QALY (least favorable scenario). Conclusions: Palivizumab is a cost-effective therapy as prophylaxis against RSV in infants with GA 32-35 and two or more RF. Its use is efficient from the NHS perspective, since the cost of a QALY, even in the least favorable scenarios, is lower than the threshold of 30,000 €/QALY considered socially acceptable in Spain.