Elhassan Nahed O, Sorbero Melony E S, Hall Caroline B, Stevens Timothy P, Dick Andrew W
Division of Neonatology, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, USA.
Arch Pediatr Adolesc Med. 2006 Oct;160(10):1070-6. doi: 10.1001/archpedi.160.10.1070.
To evaluate the cost-effectiveness of palivizumab as respiratory syncytial virus prophylaxis in premature infants without chronic lung disease and to evaluate the impact on cost-effectiveness of a potential reduction in risk of asthma following respiratory syncytial virus infection among infants receiving palivizumab.
Two decision analytic models were designed, one with and the other without accounting for increased risk of asthma following respiratory syncytial virus infection.
A hypothetical community or university hospital.
Hypothetical cohorts of infants without chronic lung disease born at 26 to 32 weeks' gestation.
Palivizumab prophylaxis vs no prophylaxis.
Expected costs and incremental cost-effectiveness ratio expressed as cost per quality-adjusted life-year.
The expected costs were higher for palivizumab prophylaxis as compared with no prophylaxis. The incremental cost-effectiveness ratios were high for all gestations and are not considered cost-effective by today's standards (<$200 000 per quality-adjusted life-year). Both models were sensitive to variation in the cost of palivizumab. The model that included asthma was sensitive to variation in quality of life for children with asthma. In instances where asthma was considered severe with profound worsening in quality of life compared with life without asthma, some infants had an incremental cost per quality-adjusted life-year that was less than $200 000.
Our model supports implementing more restrictive guidelines for palivizumab prophylaxis. Palivizumab was cost-effective for some infants in an analysis that accounted for increased risk of severe asthma following respiratory syncytial virus infection.
评估帕利珠单抗作为呼吸道合胞病毒预防用药在无慢性肺病的早产儿中的成本效益，并评估帕利珠单抗对感染呼吸道合胞病毒的婴儿哮喘风险潜在降低所产生的成本效益影响。
设计了两个决策分析模型，一个考虑呼吸道合胞病毒感染后哮喘风险增加，另一个不考虑。
假设的社区或大学医院。
妊娠26至32周出生的无慢性肺病的假设婴儿队列。
帕利珠单抗预防与不预防。
预期成本和增量成本效益比，以每质量调整生命年的成本表示。
与不预防相比，帕利珠单抗预防的预期成本更高。所有孕周的增量成本效益比都很高，按照当今标准（每质量调整生命年<$200 000）不被认为具有成本效益。两个模型对帕利珠单抗成本的变化都很敏感。包含哮喘因素的模型对哮喘儿童的生活质量变化敏感。在哮喘被认为严重且与无哮喘的生活相比生活质量显著恶化的情况下，一些婴儿每质量调整生命年的增量成本低于200 000美元。
我们的模型支持对帕利珠单抗预防实施更严格的指南。在一项考虑呼吸道合胞病毒感染后严重哮喘风险增加的分析中，帕利珠单抗对一些婴儿具有成本效益。
