Medical Outcomes and Research in Economics Group, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada.
J Med Econ. 2009;12(4):361-70. doi: 10.3111/13696990903442155.
Canadian, Inuit, full term infants have the highest rate of respiratory syncytial virus (RSV) infection globally, which results in substantial costs associated hospitalisation.
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.
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.
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.
加拿大因纽特人足月婴儿的呼吸道合胞病毒（RSV）感染率居全球最高，这导致与住院相关的费用巨大。
使用决策分析技术来估算帕利珠单抗与所有胎龄因纽特婴儿无预防措施相比的增量成本效益比（ICER）。时间范围是终生随访，成本和效果以每年 5%贴现。基于加拿大付款人的角度，计算了帕利珠单抗、住院（包括医疗后送、重症监护病房[ICU]）、医生就诊和交通的成本（2007 加元）。减少 RSV 住院的益处表示为质量调整生命年（QALY）。进行了单因素和概率敏感性分析（PSA），变量包括：死亡率、效用、住院和 ICU 停留时间。
对于巴芬岛所有婴儿（<1 岁），ICER 为 39,435 加元/QALY。然而，当按年龄和居住地分组时，居住在伊魁特（<1 岁）的婴儿的 ICER 为 152,145 加元/QALY，而居住在农村地区（伊魁特以外）的婴儿的 ICER 为 24,750 加元/QALY。预防措施对于 6 个月以下的农村婴儿是一种具有成本效益的策略（节省成本），PSA 表明该策略在 98%的情况下占主导地位。
与无预防措施相比，帕利珠单抗对巴芬岛因纽特婴儿预防 RSV 的成本效益比表明，它是一种有效的选择。帕利珠单抗在<1 岁且特别居住在伊魁特以外的北极婴儿中具有高度成本效益，并且对于 6 个月以下的农村地区婴儿是一种占主导地位的策略。然而，对于所有年龄居住在伊魁特的婴儿，帕利珠单抗与无治疗相比并不具有成本效益。
