Shahabi Ahva, Peneva Desi, Incerti Devin, McLaurin Kimmie, Stevens Warren
Precision Health Economics, 11100 Santa Monica Blvd, Suite 500, Los Angeles, CA, 90025, USA.
AstraZeneca, One MedImmune Way, Gaithersburg, MD, 20878, USA.
Pharmacoecon Open. 2018 Mar;2(1):53-61. doi: 10.1007/s41669-017-0042-3.
The variability in cost of palivizumab treatment, indicated for prevention of respiratory syncytial virus (RSV) infections in high-risk infants, has not been robustly estimated in prior studies. This study aimed to determine the cost variations of palivizumab from a US payer perspective for otherwise healthy preterm infants born 29-35 weeks gestational age (wGA) using infant characteristics and applied dosing regimens.
Fenton Growth Charts were merged with World Health Organization Child Growth Standards to estimate preterm infant growth patterns. The merged growth chart was applied to infants who received palivizumab from a prospective, observational registry to determine future body weight using each infant's wGA and birth weight. Using quarter 3 (Q3) 2016-Q2 2017 vial cost, treatment costs at monthly dosing intervals were estimated using expected weights and averaged by age to derive expected mean 2016-2017 RSV seasonal costs per infant under various dosing scenarios.
Given different dosing scenarios (two to five doses), birth month, and growth patterns for preterm infants 29-35 wGA, the estimated average 2016-2017 seasonal cost of palivizumab treatment ranged from $3221 to $12,568. Outpatient-only cost (excluding first dose at hospital discharge) ranged from $1733 to $11,862. The main drivers of costs were dosing regimen (74% of variance), dosing interacted with birth month (17%), and wGA (6%).
The considerable variability in the average cost of palivizumab treatment for preterm infants is driven by choice of dosing regimen, wGA, and birth month. Therefore, when estimating the cost of palivizumab, it is important to consider both infant characteristics at each dose and potential dosing regimens.
帕利珠单抗用于预防高危婴儿呼吸道合胞病毒（RSV）感染，此前研究尚未对其治疗成本的变异性进行充分评估。本研究旨在从美国医保支付方的角度，利用婴儿特征和应用的给药方案，确定孕龄29 - 35周（wGA）的健康早产婴儿使用帕利珠单抗的成本差异。
将芬顿生长图表与世界卫生组织儿童生长标准合并，以估计早产婴儿的生长模式。将合并后的生长图表应用于前瞻性观察登记中接受帕利珠单抗治疗的婴儿，根据每个婴儿的wGA和出生体重确定其未来体重。使用2016年第3季度至2017年第2季度的药瓶成本，根据预期体重估算每月给药间隔的治疗成本，并按年龄平均，得出不同给药方案下每个婴儿2016 - 2017年RSV季节预期平均成本。
考虑到29 - 35 wGA早产婴儿不同的给药方案（2至5剂）、出生月份和生长模式，2016 - 2017年帕利珠单抗治疗的估计平均季节成本为3221美元至12568美元。仅门诊成本（不包括出院时的首剂）为1733美元至11862美元。成本的主要驱动因素是给药方案（占方差的74%）、给药与出生月份的相互作用（17%）以及wGA（6%）。
早产婴儿帕利珠单抗治疗平均成本的显著差异是由给药方案、wGA和出生月份的选择驱动的。因此，在估算帕利珠单抗成本时，考虑每次给药时的婴儿特征和潜在给药方案非常重要。
