Cost-effectiveness of palivizumab in infants with congenital heart disease: a Swedish perspective
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(2020) 4:5
Journal of Congenital Cardiology
RESEARCH ARTICLE
Open Access
Cost-effectiveness of palivizumab in infants with congenital heart disease: a Swedish perspective Eva Fernlund1, Martin Eriksson2, Jonas Söderholm2,3, Jan Sunnegårdh4 and Estelle Naumburg5*
Abstract Background: Infants with congenital heart disease (CHD) have an increased risk of morbidity and mortality during a respiratory syncytial virus (RSV) infection. The aim of this study was to estimate the cost-effectiveness of palivizumab as RSV-prophylaxis among infants with CHD, including the effect of delayed heart surgery and asthma. Methods: A simulation model with data from the literature and health care authorities including costs and utilities was developed to estimate costs and health effects over a lifetime for a cohort of CHD infants receiving palivizumab compared to no RSV-prophylaxis. Results: The prophylaxis treatment incurred a cost of 3664 EUR per treated infant. However, due to cost-savings from primarily avoiding hospitalizations (5145 EUR/treated infant) and avoiding heart complications due to delayed heart surgery (2082 EUR/treated infant), the RSV-prophylaxis treatment resulted in a total cost-saving of 3833 EUR per treated infant. At the same time, the prophylaxis-treated cohort accumulated more life-years and higher quality of life than the non-prophylaxis cohort. Conclusion: This study confirms that RSV-prophylaxis in severe CHD infants less than one year of age is cost beneficial. Avoiding delayed heart surgeries is an important benefit of prophylaxis and should be taken into consideration. Keywords: Congenital heart defect, Cost-effectiveness analyses, Palivizumab, Prophylaxis, RSV-infection
Background Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections (LRTI) in infants and young children. Severe RSV may result in acute respiratory failure and hospitalization with supplemental oxygen, mechanical ventilation, and intensive care (ICU), especially for infants and children at risk [1, 2]. Infants with congenital heart disease (CHD) carry a risk of morbidity and mortality from RSV infection worldwide as well as in Scandinavia [3, 4]. Long-term sequelae from RSV-infections are wheezing and asthma [5–8]. * Correspondence: [email protected] 5 Department of Clinical Science, Paediatrics, Umeå University, Umeå, Sweden Full list of author information is available at the end of the article
Cardiac surgery performed during an ongoing RSV infection is associated with a high risk of postoperative complications, prolonged postoperative stay at the pediatric intensive care unit (PICU), and morbidity [9– 11]. Postponing cardiac surgery is thus appropriate in infants with symptomatic viral respiratory infection. However, postponing will, on the other hand, increase the risk of morbidity and mortality induced by the cardiac disease. Palivizumab (Synagis®, MedImmune) is a monoclonal antibody designed to provide passive immunity against RSV – thereby reducing the severity of RSV infection in i
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