The cost effectiveness of palivizumab in congenital heart disease: a review of the current evidence

Abstract

Objective:

To review and summarize the literature concerning the cost-effectiveness of palivizumab compared to no prophylaxis in infants and young children with congenital heart disease (CHD).

Methods:

A systematic literature search (MEDLINE to March 2012, limited to English language) identified studies that examined the cost-effectiveness of palivizumab in CHD populations. The quality of each study was assigned a quality score of 1–100 based on the Quality of Health Economic Studies (QHES) instrument.

Results:

Ten studies were identified through the search strategy, of which four principally addressed the research question and six additional articles examined CHD in conjunction with other high-risk indications for palivizumab in their economic analyses. QHES for the studies ranged from 58–100, with a median score of 93 (76 for principal articles, 94 for secondary analyses). Cost-utility analyses, which evaluated costs per quality-adjusted life year (QALY), showed favorable results in five analyses (range $10,329–$16,648 per QALY), while the other two suggested no cost-effectiveness ($146,061 and $169,971 per QALY). Of three cost-effectiveness analyses, which assessed costs per hospital admission prevented (HAP), two concluded that the drug was not cost-effective ($16,216/day of hospitalization prevented and $868,296/HAP), while one did not interpret the final result ($43,561/HAP).

Limitations:

Significant variance exists across study characteristics, analytic models utilized, duration of RSV seasons assessed, primary outcome measures evaluated, sensitivity analyses conducted, and other model assumptions. Further, it was difficult to obtain true CHD-based quality scores for the studies that analyzed more than one indication.

Conclusions:

The findings of this review currently remain inconclusive. Although a favorable trend was identified in the cost-utility analyses, additional rigorously conducted studies are necessary to better estimate the cost-effectiveness of palivizumab for CHD infants in clinical practice.

Keywords::

• Congenital heart disease (CHD)
• Respiratory syncytial virus (RSV)
• Palivizumab
• Cost-effectiveness

Transparency

Declaration of funding

This study was not funded.

Declaration of financial/other relationships

KL and BP have disclosed that they have received grants from and are on the Speakers’ Bureau for Abbott and MedImmune. Both KL and BP have previously acted as consultants to Abbott. KL and JH have disclosed that they are employees of Sunnybrook Health Sciences Centre. BP is an employee of McMaster University.