Banerji Anna, Ng Kaspar, Moraes Theo J, Panzov Vladimir, Robinson Joan, Lee Bonita E
Li Ka Shing Knowledge Institute (Banerji), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Banerji), University of Toronto, Toronto, Ont.; Department of Pediatrics (Ng), University of Calgary, Calgary, Alta.; Hospital for Sick Children (Moraes); Applied Health Research Centre (Panzov), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Stollery Children's Hospital (Robinson) and Department of Pediatrics (Lee), Faculty of Medicine, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta.
CMAJ Open. 2016 Oct 18;4(4):E623-E633. doi: 10.9778/cmajo.20150052. eCollection 2016 Oct-Dec.
Hospital admissions for respiratory syncytial virus infection result in large health expenditures for Inuit infants. Palivizumab has been shown to be highly effective in reducing such admissions in preterm Inuit infants. We performed a cost-effectiveness analysis estimating the incremental cost-effectiveness ratio (ICER) for palivizumab prophylaxis per admission related to respiratory syncytial virus avoided in healthy term infants across the Canadian Arctic.
We compared universal palivizumab prophylaxis in term infants less than 6 months of age to no prophylaxis in 8 Arctic regions: the Northwest Territories, Nunavut, Nunavut without Iqaluit, the 3 subregions of Nunavut (Kitikmeot, Kivalliq and Qikiqtaaluk), the Qikiqtaaluk Region without Iqaluit, and Nunavik (northern Quebec). Costs were acquired from the territorial governments, hospitals and contracted agencies. The perspective is that of the public payer, with a 6-month timeline. In scenario A, universal prophylaxis was provided until the end of the respiratory syncytial virus season, and in scenario B, infants received prophylaxis until 5 months of age. The ICERs of scenario A were compared with those of scenario B.
Under scenario A, the cost per admission avoided was as high as $546 115 in the Northwest Territories, compared with a cost savings of $36 145 in the Kitikmeot Region. Under scenario B, the ICER showed cost savings of $48 549 in the Kitikmeot Region and $2731 in the Kivalliq Region, with low ICERs in Nunavik of $15 601.
Considerable cost savings were found for the Kitikmeot Region with universal palivizumab prophylaxis in term infants with both scenarios, whereas cost savings were found for the Kivalliq Region with scenario B. Stopping prophylaxis at 5 months of age was a more cost-effective strategy in all regions except the Kitikmeot Region. Nunavik had low ICERs, and prophylaxis should be considered for this region.
呼吸道合胞病毒感染导致因纽特婴儿的住院治疗产生巨额医疗费用。帕利珠单抗已被证明在降低早产因纽特婴儿的此类住院率方面非常有效。我们进行了一项成本效益分析，估计了加拿大北极地区健康足月儿中，每预防一次与呼吸道合胞病毒相关的住院，使用帕利珠单抗的增量成本效益比（ICER）。
我们在8个北极地区比较了对6个月以下足月儿进行普遍的帕利珠单抗预防与不进行预防的情况：西北地区、努纳武特地区、不包括伊魁特的努纳武特地区、努纳武特的3个分区（基蒂克米奥特、基瓦利克和奇基塔卢克）、不包括伊魁特的奇基塔卢克地区以及努纳维克（魁北克北部）。成本来自地区政府、医院和签约机构。视角是公共支付方的视角，时间跨度为6个月。在方案A中，普遍预防持续到呼吸道合胞病毒季节结束，在方案B中，婴儿接受预防直到5个月大。将方案A的ICER与方案B的ICER进行比较。
在方案A下，西北地区每避免一次住院的成本高达546,115美元，而基蒂克米奥特地区则节省成本36,145美元。在方案B下，ICER显示基蒂克米奥特地区节省成本48,549美元，基瓦利克地区节省成本2,731美元，努纳维克的ICER较低，为15,601美元。
在两种方案下，对足月儿进行普遍的帕利珠单抗预防，基蒂克米奥特地区都实现了可观的成本节省，而在方案B下，基瓦利克地区实现了成本节省。在除基蒂克米奥特地区外的所有地区，在5个月大时停止预防是一种更具成本效益的策略。努纳维克的ICER较低，该地区应考虑进行预防。
