Department of Pediatrics, Erasmus MC-Sophia, Rotterdam 3000 CB, the Netherlands.
Arch Dis Child. 2010 Jul;95(7):493-8. doi: 10.1136/adc.2008.155556. Epub 2010 May 26.
The cost-effectiveness of passive immunisation against respiratory syncytial virus (RSV) in the Netherlands was studied by assessing incremental costs to prevent one hospitalisation in high-risk children using a novel individualised monthly approach.
Cost-effectiveness analysis was performed by combining estimates of individual hospitalisation costs and monthly hospitalisation risks, with immunisation costs, parental costs and efficacy of passive immunisation for a reference case with the highest hospitalisation risks and costs of hospitalisation during the RSV season (male, gestational age < or =28 weeks, birth weight < or =2500 g, having bronchopulmonary dysplasia (BPD), aged 0 months at the beginning of the season (October)). Various sensitivity analyses and a cost-neutrality analysis were performed.
Cost-effectiveness of passive immunisation varied widely by child characteristics and seasonal month. For the reference case it was most cost effective in December at euro13,190 per hospitalisation averted. Cost-effectiveness was most sensitive to changes in hospitalisation risk. For the reference case, cost neutrality was reached in December, if acquisition costs of passive immunisation decreased from euro 930 to euro 375, monthly hospitalisation risk increased from 7.6% to 17%, or hospitalisation costs increased from euro 10 250 to euro 23 250 per hospitalisation. Even if passive immunisation prevented all hospitalisations, costs per hospitalisation averted in December would still exceed euro 2645.
Although cost-effectiveness of passive immunisation varied strongly by child characteristics and seasonal month, incremental costs per hospitalisation averted were always high. A restrictive immunisation policy only immunising children with BPD in high-risk months is therefore recommended. The costs of passive immunisation would have to be considerably reduced to achieve cost-effectiveness.
通过评估使用新型个体化每月方法预防高危儿童住院的增量成本，研究针对呼吸道合胞病毒（RSV）的被动免疫接种在荷兰的成本效益。
通过将个体住院成本和每月住院风险的估计值与免疫接种成本、父母成本以及被动免疫接种的疗效相结合，对成本效益进行了分析，为参考病例提供了最高的住院风险和 RSV 季节住院成本（男性，<或=28 周的胎龄，<或=2500 克的出生体重，患有支气管肺发育不良（BPD），0 个月时开始季节（十月））。进行了各种敏感性分析和成本中性分析。
被动免疫接种的成本效益因儿童特征和季节性月份而异。对于参考病例，12 月的成本效益最高，每例避免住院的费用为 13190 欧元。成本效益对住院风险的变化最为敏感。对于参考病例，如果被动免疫接种的获得成本从 930 欧元降至 375 欧元，每月住院风险从 7.6%增加到 17%，或每例住院的住院费用从 10250 欧元增加到 23250 欧元，12 月就可以达到成本中性。即使被动免疫接种可以预防所有住院治疗，12 月每例避免住院的成本仍将超过 2645 欧元。
尽管被动免疫接种的成本效益因儿童特征和季节性月份而异，但每例避免住院的增量成本始终很高。因此，建议仅在高危月份为患有 BPD 的儿童接种疫苗。只有当被动免疫接种的成本大大降低时，才能实现成本效益。
