P170 A cost-effectiveness analysis of respiratory syncytial virus (RSV) prophylaxis in infants in the UK

Abstract

Background: and Aim RSV is the most common cause of lower respiratorytract infection in young children and may result in hospitalisations,long-termsequelae, such as recurrent wheeze and/or asthma,and possibly death. Palivizumab is a prophylaxis against severe RSVinfection and has been shown to reduce RSV-related hospitalisations,and provides a preventative option for high-risk infants. The aim ofthis study is to demonstrate the cost-effectiveness of RSV prophylaxiscompared to no prophylaxis in the following high-risk infants groups:infants with chronic lung disease (CLD) and premature babies (<29,29-32 and 33-35 weeks gestational age (wGA)). Methods: A decision-tree model was developed to reflect the clinicalpathway of infants at high-risk of severe RSV infection. Baseline riskof RSV-hospitalisations and efficacy data were taken from palivizumabclinical trials and published meta-analysis. Cost data wereobtained from national databases and published literature using anNHS perspective. The main outcome was presented as the incrementalcosts per Quality-Adjusted Life-Year (QALY) gained (ICER).The base-case analysis considered a lifetime horizon to capture theimpact of long-term morbidity and mortality associated with RSVhospitalisations. Results: Prophylaxis against severe RSV infection resulted in ICERsof £19 168, £18 174 & £1185 per QALY for high-risk infants with,CLD and the premature infant groups, <29 wGA and 29-32 wGArespectively compared to no prophylaxis. All results are below theaccepted NICE threshold of £30 000 /QALY thus demonstratingcost-effectiveness. The baseline ICER for the 33-35 wGA subgroupwas above this threshold however, sensitivity analysis consideringrisk-factors in this subgroup showed that an increase in baseline riskof hospitalisation, from 7.2% to 11.24%, led to palivizumabbecoming a cost-effective option. Conclusions: Severe RSV infection in high-risk infants represents asignificant cause of morbidity and mortality and is associated with ahigh economic burden. Palivizumab was found to be cost-effectivecompared to no prophylaxis in the UK in all of the subgroupsconsidered, demonstrating a good use of NHS resources.