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Study fails to establish cost-effectiveness of using palivizumab to prevent RSV infection in preterm infants

Administering the drug palivizumab—a humanized monoclonal antibody—reduces hospitalizations for serious respiratory syncytial virus (RSV) lower respiratory tract infections, such as bronchiolitis, in at-risk infants. These include preterm infants and infants born with certain underlying conditions that predispose them to respiratory complications.

Bronchiolitis care costs can be substantial, given the frequent need for supplemental oxygen and time spent in the neonatal intensive care unit. Palivizumab prophylaxis is costly as well at $1,214 per injection (with an average of four injections given to an infant to prevent RSV-related infections).

In a recent study, researchers compared the direct costs of palivizumab prophylaxis and RSV treatment in infants younger than 1 year who were born at 32 to 35 weeks gestation and received palivizumab (185 infants) with those who did not receive palivizumab (182 infants). The subjects were enrolled in an enhanced primary care case management program within the North Carolina Medicaid program. The researchers found that the direct costs of providing palivizumab far outweigh the costs of care for RSV-attributed bronchiolitis. The study was supported by the Agency for Healthcare Research and Quality through a cooperative agreement (HS10397) with the University of North Carolina Center for Education and Research on Therapeutics (CERT).

The prophylaxis infants received an average of four injections of palivizumab between October 2002 and March 2003. The average per-person total costs of RSV care (hospitalization and outpatient care) and prophylaxis was $5,117 for the prophylaxis group and $371 for the nonprophylaxis group. This difference was primarily due to the cost of palivizumab. Five hospitalizations occurred in the prophylaxis group and 12 in the nonprophylaxis group. No deaths occurred in either group. Other risk factors for RSV infection, such as day care attendance and exposure to cigarette smoke in the home, did not alter the results.

See "Direct cost analyses of palivizumab treatment in a cohort of at-risk children: Evidence from the North Carolina Medicaid program," by Steven Wegner, M.D., J.D., Julie Jacobson Vann, Ph.D., Gordon Liu, Ph.D., and others, in the December 2004 Pediatrics 114(6), pp. 1612-1619.

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