Document Detail


Cost utility of palivizumab prophylaxis among pre-term infants in the United States: a national policy perspective.
MedLine Citation:
PMID:  22574798     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The cost-effectiveness of palivizumab has previously been reported among certain guideline-eligible, high-risk premature infants in Medicaid. Because guideline authorities base decisions on a national perspective, the economic model of palivizumab was adapted to include all infants, that is, public and privately insured patients (60% of palivizumab use is public, 40% is private).
METHODS: This study examined four groups of premature infants without chronic lung disease of prematurity or congenital heart disease: (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 (RFs); (3) 32-35 wGA, ≤ 6 months CA, with 2006 AAP RFs; and (4) 32-35 wGA, ≤ 6 months CA, with ≤ 1 RF. An average estimate was used between public and private payors for (1) background rates of respiratory syncytial virus hospitalization (RSV-H), (2) direct medical costs associated with RSV-H, and (3) cost of palivizumab. Incremental cost-effectiveness ratios (ICERs) are reported in cost per quality-adjusted life-year (QALY) gained. Sensitivity analyses were performed.
RESULTS: Palivizumab saved costs and improved QALYs among infants <32 wGA. Palivizumab was cost-effective in infants 32-34 wGA with 2009 AAP RFs ($44,774 per QALY) and in infants 32-35 wGA with 2006 AAP RFs ($79,477 per QALY). The ICER for infants 32-35 wGA with ≤ 1 RF was $464,476 per QALY. Influential variables in the sensitivity analysis included background rate of RSV-H and cost and efficacy of palivizumab.
LIMITATIONS: The results are not generalizable to populations outside of the US. The model did not examine all RFs. The wholesale acquisition cost was used as a payment benchmark; actual price paid by end providers varies.
CONCLUSIONS: From a national policy perspective, palivizumab remained cost-effective for publically and commercially insured, guideline-eligible, high-risk premature infants. Palivizumab was not cost-effective in infants of 32-35 wGA with ≤ 1 RF.
Authors:
Parthiv J Mahadevia; Anthony S Masaquel; Mark J Polak; Leonard B Weiner
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-05-10
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:  2014-07-31    
Medline Journal Info:
Nlm Unique ID:  9892255     Medline TA:  J Med Econ     Country:  England    
Other Details:
Languages:  eng     Pagination:  987-96     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Antibodies, Monoclonal, Humanized / economics*,  therapeutic use
Antiviral Agents / economics*,  therapeutic use
Cost-Benefit Analysis
Health Care Costs
Health Policy*
Humans
Infant, Newborn
Infant, Premature*
Insurance Coverage
Insurance, Health
Models, Economic
Quality-Adjusted Life Years
Respiratory Syncytial Virus Infections / economics,  prevention & control
Sensitivity and Specificity
United States
Chemical
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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