Objectives To assess the cost-effectiveness of palivizumab prophylaxis used to prevent RSV hospitalization (RSVH) in preterm infants with special regard to long-term consequences represented by recurrent wheezing.

Methods An economic model was used to estimate the cost-effectiveness of palivizumab prophylaxis in preterm infants in an international cohort of 436 children from 5 European countries and Canada, over a period of 3 years. Data sources included published literature, the Palivizumab Long -term Respiratory Outcomes Study (PLTROS), and official price/tariff lists. Effectiveness was defined as avoided cases (children) of recurrent wheezing. The study was conducted from a societal perspective. To calculate an average estimator, the costs obtained from different countries were adjusted to a 2007 German setting. Results were discounted by 5% according to international guidelines. Sensitivity analyses were performed.

Results The effectiveness of palivizumab showed slightly different results in the various settings. However, larger differences between them were observed in the cost-effectiveness ratios. Palivizumab prophylaxis was dominant in Canada, Sweden, and Poland, where the savings per case avoided ranged from ?22,587 to ?8,374; ?75,400 to ?34,397 and ?12,086 to ?8,868, respectively. In Spain, the incremental cost per case avoided ranged from ?5,374 to ?7,308 dependent on the definition of recurrent wheezing. The global average incremental cost per case avoided ranged from ?5,510 to ?10,046.

Conclusion Palivizumab provides cost-effective prophylaxis against RSV infection in preterm infants. The inclusion of the positive influence on preventing recurrent wheezing may result in further cost savings compared to short-term assessments.

Funded by Abbott.