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The cost effectiveness of palivizumab in term Inuit infants in the Eastern Canadian Arctic.
MedLine Citation:
PMID:  19900071     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
INTRODUCTION: Canadian, Inuit, full term infants have the highest rate of respiratory syncytial virus (RSV) infection globally, which results in substantial costs associated hospitalisation.
METHODS: Decision-analytical techniques were used to estimate the incremental cost-effectiveness ratio (ICER) for palivizumab compared to no prophylaxis for Inuit infants of all gestational age. The time horizon was that of life-time follow-up, and costs and effectiveness were discounted at 5% per year. Costs (2007 CAD$) for palivizumab, hospitalisation (including medical evacuation, intensive care unit [ICU]), physician visits, and transportation were calculated based on the Canadian payer's perspective. Benefits on decreasing RSV hospitalisation were expressed as quality-adjusted life-years (QALYs). One-way and probabilistic sensitivity analysis (PSA) were conducted, varying: mortality rates, utilities, length of stay in hospital and ICU.
RESULTS: For all of Baffin Island infants (<1 year), the ICER was $39,435/QALY. However, when infants were grouped by age and area of residence, those residing in Iqaluit (<1 year) had an ICER of $152,145/QALY, while those residing in rural areas (outside of Iqaluit) had an ICER of $24,750/QALY. Prophylaxis was a dominant strategy (cost saving) for rural infants under 6 months of age, with the PSA demonstrating that it was dominant 98% of the time.
CONCLUSIONS: The ICERs suggested that palivizumab is a cost-effective option for the prevention of RSV for Inuit infants on Baffin Island compared to no prophylaxis. Palivizumab is highly cost effective in Arctic infants <1 year of age specifically residing outside of Iqaluit and is a dominant strategy for those under 6 months of age in rural areas. However, palivizumab is not cost effective compared to no treatment for infants of all ages residing in Iqaluit.
Authors:
Derrick Y Tam; Anna Banerji; Bosco A Paes; Charles Hui; Jean-Eric Tarride; Krista L Lanctôt
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of medical economics     Volume:  12     ISSN:  1941-837X     ISO Abbreviation:  J Med Econ     Publication Date:  2009  
Date Detail:
Created Date:  2009-12-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9892255     Medline TA:  J Med Econ     Country:  England    
Other Details:
Languages:  eng     Pagination:  361-70     Citation Subset:  IM    
Affiliation:
Medical Outcomes and Research in Economics Group, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada.
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