Cost-effectiveness of Palivizumab for Respiratory Syncytial Virus: A Systematic Review

CONTEXT:Palivizumab prophylaxis is used as passive immunization for respiratory syncytial virus (RSV). However, because of its high cost, the value of this intervention is unclear.OBJECTIVE:To systematically review the cost-effectiveness of palivizumab prophylaxis compared with no prophylaxis in infants <24 months of age.DATA SOURCES:Medline, Embase, and Cochrane Library up to August 2018.STUDY SELECTION:Two reviewers independently screened results to include economic evaluations conducted between 2000 and 2018 from Organization for Economic Cooperation and Development countries.DATA EXTRACTION:Two reviewers independently extracted outcomes. Quality appraisal was completed by using the Joanna Briggs Institute checklist. Costs were adjusted to 2017 US dollars.RESULTS:We identified 28 economic evaluations (20 cost-utility analyses and 8 cost-effectiveness analyses); most were from the United States (n = 6) and Canada (n = 5). Study quality was high; 23 studies met >80% of the Joanna Briggs Institute criteria. Palivizumab prophylaxis ranged from a dominant strategy to having an incremental cost-effectiveness ratio of $2526203 per quality-adjusted life-year (QALY) depending on study perspective and targeted population. From the payer perspective, the incremental cost-effectiveness ratio for preterm infants (29-35 weeks' gestational age) was between $5188 and $791265 per QALY, with 90% of estimates <$50000 per QALY. Influential parameters were RSV hospitalization reduction rates, palivizumab cost, and discount rate.LIMITATIONS:Model design heterogeneity, model parameters, and study settings were barriers to definitive conclusions on palivizumab's economic value.CONCLUSIONS:Palivizumab as RSV prophylaxis was considered cost-effective in prematurely born infants, infants with lung complications, and infants from remote communities.