Document Detail

Cost-effectiveness analysis of palivizumab among pre-term infant populations covered by Medicaid in the United States.
MedLine Citation:
PMID:  22435648     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Medicaid infants are at high risk of severe respiratory syncytial virus (RSV) disease. The study objective was to estimate the cost-effectiveness of palivizumab in a Medicaid population.
METHODS: A societal cost-utility analysis was conducted of prophylaxis with palivizumab vs no prophylaxis among four groups of premature infants: (1) <32 weeks gestational age (wGA) and ≤ 6 months chronologic age (CA); (2) 32-34 wGA, ≤ 3 months CA with 2009 American Academy of Pediatrics (AAP) risk factors (RF); (3) 32-35 wGA, ≤ 6 months CA with 2006 AAP RF; and (4) 32-35 wGA, ≤ 6 months CA with ≤ 1 RF. Full dosing of palivizumab was assumed throughout the RSV season (consistent with the FDA-approved label). All costs were in 2010 US dollars. The societal public payer spend for palivizumab was estimated using Medicaid reimbursement methodologies for the top 10 palivizumab-using states in 2010 minus mandatory manufacturer rebates. This study reports the incremental cost-effectiveness ratios (ICERs) in cost per quality-adjusted life-year (QALY) gained. Sensitivity and probabilistic analyses were also conducted.
RESULTS: Palivizumab saved costs and improved QALYs among infants <32 wGA. Palivizumab was cost-effective in infants 32-34 wGA with 2009 AAP RF ($16,037 per QALY) and in infants 32-35 wGA with 2006 AAP RF ($38,244 per QALY). The ICER for infants 32-35 wGA with ≤ 1 RF was $281,892 per QALY. Influential variables in the sensitivity analysis included the background rate of RSV hospitalization, the cost of palivizumab, and the efficacy of palivizumab.
KEY LIMITATIONS: These results are not generalizable to commercially insured infants or infants outside of the US.
CONCLUSIONS: This is the first cost-utility analysis of palivizumab in a Medicaid population. Palivizumab, when dosed consistent with the FDA-approved labeling, was either cost-saving or cost-effective among current guideline-eligible infants in the Medicaid population. Palivizumab did not demonstrate cost-effectiveness in 32-35 wGA infants with ≤ 1 RF.
Leonard B Weiner; Anthony S Masaquel; Mark J Polak; Parthiv J Mahadevia
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-03-21
Journal Detail:
Title:  Journal of medical economics     Volume:  15     ISSN:  1941-837X     ISO Abbreviation:  J Med Econ     Publication Date:  2012  
Date Detail:
Created Date:  2012-08-13     Completed Date:  2013-01-14     Revised Date:  2013-11-06    
Medline Journal Info:
Nlm Unique ID:  9892255     Medline TA:  J Med Econ     Country:  England    
Other Details:
Languages:  eng     Pagination:  997-1018     Citation Subset:  IM    
State University of New York, Upstate Medical University, Department of Pediatrics, Syracuse, NY, USA.
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MeSH Terms
Antibodies, Monoclonal, Humanized / economics*,  therapeutic use
Antiviral Agents / economics*,  therapeutic use
Cost-Benefit Analysis
Gestational Age
Infant, Newborn
Insurance Coverage*
Intensive Care Units
Models, Economic
Quality-Adjusted Life Years
Respiratory Syncytial Virus Infections / complications,  prevention & control
United States
Reg. No./Substance:
0/Antibodies, Monoclonal, Humanized; 0/Antiviral Agents; 0/palivizumab

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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