Robbins J M, Tilford J M, Jacobs R F, Wheeler J G, Gillaspy S R, Schutze G E
Center for Applied Research and Evaluation, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock 72202, USA.
Arch Pediatr Adolesc Med. 1998 Apr;152(4):358-66. doi: 10.1001/archpedi.152.4.358.
To estimate how many infants in selected high-risk subgroups would require treatment with respiratory syncytial virus immune globulin (RSV-IG) to avoid 1 hospital admission and to determine whether this is economically justified.
Cost-benefit analysis. Data from 3 randomized controlled trials of RSV-IG are used to estimate the number needed to treat to prevent 1 hospital admission for respiratory syncytial virus infection. The threshold number needed to treat is computed according to a formula incorporating costs and benefits of RSV-IG prophylaxis. Estimates of the willingness to pay were obtained from a sample of 39 health care providers (35 physicians and 4 nurses).
The number needed to treat to prevent 1 hospital admission for respiratory syncytial virus infection. The threshold number needed to treat that would balance costs with benefits.
More than 16 (95% confidence interval, 12.5-23.8) infants would need to be treated with RSV-IG to avoid 1 hospital admission for respiratory syncytial virus infection, ranging from 63 for premature infants without chronic lung disease to 12 (confidence interval, 6.3-100.0) for infants with bronchopulmonary dysplasia. A sensitivity analysis of the costs and values of hospital admission for respiratory syncytial virus infection and RSV-IG treatment resulted in a weak recommendation against the treatment of infants with bronchopulmonary dysplasia and strong recommendations that the costs and risks of RSV-IG treatment outweigh the benefits for the combined sample of infants and premature infants without lung disease.
The number-needed-to-treat procedures offer a method to assess evidence of treatment effects and decision rules for whether to accept treatment recommendations. Under plausible assumptions, treatment with RSV-IG is not recommended for infants without lung disease. Institutions can examine cost and benefit assumptions that best fit their own practice setting.
评估特定高危亚组中有多少婴儿需要接受呼吸道合胞病毒免疫球蛋白（RSV-IG）治疗以避免1次住院，并确定这样做在经济上是否合理。
成本效益分析。使用来自3项RSV-IG随机对照试验的数据来估计预防1次呼吸道合胞病毒感染住院所需治疗的人数。根据纳入RSV-IG预防成本和效益的公式计算所需治疗的阈值人数。从39名医疗服务提供者（35名医生和4名护士）的样本中获得支付意愿的估计值。
预防1次呼吸道合胞病毒感染住院所需治疗的人数。使成本与效益平衡所需治疗的阈值人数。
超过16名（95%置信区间为12.5 - 23.8）婴儿需要接受RSV-IG治疗以避免1次呼吸道合胞病毒感染住院，其中无慢性肺病的早产儿为63名，支气管肺发育不良的婴儿为12名（置信区间为6.3 - 100.0）。对呼吸道合胞病毒感染住院和RSV-IG治疗的成本及价值进行敏感性分析后，得出不建议对支气管肺发育不良婴儿进行治疗的微弱建议，以及强烈建议对于无肺病的婴儿和早产儿的合并样本，RSV-IG治疗的成本和风险超过效益。
所需治疗人数程序提供了一种评估治疗效果证据以及决定是否接受治疗建议的决策规则的方法。在合理假设下，不建议无肺病的婴儿使用RSV-IG治疗。各机构可以审查最适合其自身实践环境的成本和效益假设。
