Banerji Anna, Lanctôt Krista L, Paes Bosco A, Masoud Shababa T, Tam Derrick Y, Macdonald W Alexander, Roberts Ann
Department of Pediatrics and Dalla Lana School of Public Health, St. Michael's Hospital, University of Toronto, Toronto, Canada.
Pediatr Infect Dis J. 2009 Aug;28(8):702-6. doi: 10.1097/INF.0b013e31819df78e.
The objectives were to compare actual respiratory syncytial virus (RSV) hospitalization rates and costs in a cohort of Inuit infants to hypothetical palivizumab prophylaxis strategies for infants of all gestational ages in the Eastern Canadian Arctic.
Incidence and costs of RSV hospitalization were collected for infants admitted to the Baffin Regional Hospital in 2002, before the initiation of palivizumab. There was a comparison of the actual costs to the costs associated with 8 palivizumab strategies stratified by age (<6 months, <1 year) and location (overall, town [Iqaluit], rural communities). It was assumed that each category would receive universal palivizumab prophylaxis resulting in a 78% decrease in RSV admissions. The net costs incurred, number needed to treat (NNT), and incremental costs per hospitalization avoided were calculated for each comparison.
There was a great variation in the rates and costs associated with RSV admissions between Iqaluit and the communities. For infants <1 year of age residing in Iqaluit, the mean admission cost was $3915, and palivizumab prophylaxis had an NNT of 20.4 and cost of $162,551 per admission avoided. For rural infants <6 months, the mean cost of admission was $23,030, and palivizumab prophylaxis resulted in an NNT of 3.9 to 2.5 and cost savings of up to $8118 per admission avoided.
Due to the high rates and costs associated with RSV admissions, administration of palivizumab in rural communities in the Canadian Arctic to infants less than 6 months of age could result in net cost savings.
目的是比较因纽特婴儿队列中实际呼吸道合胞病毒（RSV）住院率和成本，与加拿大东部北极地区所有孕周婴儿使用帕利珠单抗预防策略的假设情况。
收集2002年帕利珠单抗使用前入住巴芬地区医院婴儿的RSV住院发病率和成本。将实际成本与按年龄（<6个月、<1岁）和地点（总体、城镇[伊魁特]、农村社区）分层的8种帕利珠单抗策略相关成本进行比较。假设每个类别都接受普遍的帕利珠单抗预防，这将使RSV入院率降低78%。计算每次比较的净成本、治疗所需人数（NNT）和避免每次住院的增量成本。
伊魁特和各社区之间RSV入院率和成本差异很大。对于居住在伊魁特的<1岁婴儿，平均入院成本为3915美元，帕利珠单抗预防的NNT为20.4，避免每次入院的成本为162551美元。对于<6个月的农村婴儿，平均入院成本为23030美元，帕利珠单抗预防导致NNT为3.9至2.5，每次入院最多节省成本8118美元。
由于RSV入院率和成本较高，在加拿大北极地区农村社区对6个月以下婴儿使用帕利珠单抗可能会节省净成本。
