Objectives 1. To determine the economic impact of RSV (respiratory syncitial virus) bronchiolitis in a 7 year birth cohort. 2. To determine whether broadening the inclusion criteria for prophylaxis would be cost-effective. Cost-effectiveness analysis of palivizumab in a mixed public-private healthcare market, as in Ireland, has not been attempted before.

Method A HIPE (hospital in-patient enquiry) computerised data analysis provided information on in-patient cases of bronchiolitis over a 7-year and 4-month period from 1999 to 2007. Gestational age, sex, age at diagnosis of bronchiolitis and length of stay were analysed. Information was compiled in a data file, cleaned, coded and analysed using SPSS version 14.0. Cost was calculated at per-bed-day rates on the premise that the babies admitted were subject to negligible cost of intervention.

Results The final number in the cohort was 533. The total cost of RSV admissions during study period was ?2,469,901.44 and these patients occupied 2489.82 bed-days over the 7 year 4 month period. The cost of vaccinations under the current guidelines was found to be greater than the cost of in-patient stay. The cost of extending the guidelines to all <37 weeks gestation did not prove cost-effective in the current Irish healthcare model.

Conclusion The economic impact of RSV prophylaxis has not, to date, been a deciding factor in the recommendations for the use of palivizumab in the mixed Irish public-private healthcare model. However, if economic ‘net-loss’ is taken as the baseline zero, a reasonable case could be made for the selective widening of the inclusion criteria.