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Cost Estimates of Prophylaxis

Cost Estimates of Prophylaxis The study by Stevens et al1 from the University of Rochester examines an important issue facing many pediatricians, neonatologists, and pulmonologists: the cost-effectiveness of immune globulin prophylaxis for respiratory syncytial virus (RSV) hospitalization. It is important in cost analyses for researchers, reviewers, and readers to carefully consider assumptions made since subsequent results may be strongly influenced by such assumptions. The authors carefully describe many of the cost assumptions made in this study. For example, effectiveness of immune globulin products in actual clinical practice was assumed to be equal to efficacy demonstrated in clinical trials, no drug wastage was assumed, overestimation of the true hospitalization rate for nonuniversity premature newborns was acknowledged, etc. The authors make 1 assumption that may not be justified, and should be clarified for readers since the resulting cost analyses would be strongly influenced. The issue is the assumed average weight of patients used in the RSV immune globulin (RSV-IGIV and palivizumab) cost analysis. In the prior RSV-IGIV and palivizumab randomized clinical trials, the mean weight of patients in control and treatment groups ranged from 4.5 to 4.9 kg2,3; however, in the Rochester report, a mean weight of 3.5 kg was assumed.1 Since the cost of prophylaxis of each patient is directly related to patient weight, this assumption would appear to result in a 30% to 40% underestimation of the actual "costs of prophylaxis" for all groups presented in Table 2 of the article. Additionally, the relationship of "cost to prevent 1 hospitalization" is not proportional to this value and would result in an even larger cost to prevent 1 hospitalization than presented in Table 3. Similar assumption effects on cost analyses have been noted previously, related to reduction in palivizumab doses required for adequate prophylaxis.4 As an example of the above concern, if an average patient weight of 4.8 kg is used (mean weight of the palivizumab group in the IMpact study) rather than 3.5 kg, the prophylaxis costs to administer palivizumab to the total group of 1029 patients becomes $3 910 591 (a 37% increase compared with the original analysis of $2 854 444). The net cost of prophylaxis then becomes $3 435 118 (the total prophylaxis charges [$3 910 591] minus the hospital costs avoided [0.55 × $864 497], or [$3 910 591-$475 473]).The net cost of prophylaxis for an individual patient becomes $3338 (3 435, 118/1029) and the cost to avoid a single hospitalization (number needed to treat = 16.6) becomes $55 410 (a 47% increase compared with the original report of $37 612). Similar underestimates would also exist in subgroup analyses. Could the authors clarify why the mean patient weight of 3.5 kg was chosen for all groups? In another cost analysis of palivizumab, Joffe et al5 utilized a weight similar to that reported in the IMpact study. Patient weight at the time of prophylaxis is a very important and perhaps underappreciated factor in cost analyses of RSV immune globulin products. References 1. Stevens TPSinkin RAHall CBManiscalco WMMcConnochie KM Respiratory syncytial vires and premature infants born at 32 weeks' gestation or earlier: hospitalization and economic implications of prophylaxis. Arch Pediatr Adolesc Med. 2000;15455- 61Google Scholar 2. The PREVENT Study Group, Reduction of respiratory syncytial virus hospitalization among premature infants and infants with bronchopulmonary dysplasia using respiratory syncytial vires immune globulin prophylaxis. Pediatrics. 1997;9993- 99Google ScholarCrossref 3. The IMpact-RSV Study Group, Palivizumab, a humanized respiratory syncytial virus monoclonal antibody, reduces hospitalization from respiratory syncytial virus infection in high-risk infants. Pediatrics. 1998;102531- 537Google ScholarCrossref 4. Moler FW RSV immune globulin prophylaxis: is an ounce of prevention worth a pound of cure [commentary]? Pediatrics. 1999;104559- 560Google ScholarCrossref 5. Joffe SRay GTEscobar GJ et al. Cost-effectiveness of respiratory syncytial virus prophylaxis among preterm infants. Pediatrics. 1999;104419- 427Google ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 2001 American Medical Association. All Rights Reserved.
ISSN
1072-4710
eISSN
1538-3628
DOI
10.1001/archpedi.155.2.199
Publisher site
See Article on Publisher Site

Abstract

The study by Stevens et al1 from the University of Rochester examines an important issue facing many pediatricians, neonatologists, and pulmonologists: the cost-effectiveness of immune globulin prophylaxis for respiratory syncytial virus (RSV) hospitalization. It is important in cost analyses for researchers, reviewers, and readers to carefully consider assumptions made since subsequent results may be strongly influenced by such assumptions. The authors carefully describe many of the cost assumptions made in this study. For example, effectiveness of immune globulin products in actual clinical practice was assumed to be equal to efficacy demonstrated in clinical trials, no drug wastage was assumed, overestimation of the true hospitalization rate for nonuniversity premature newborns was acknowledged, etc. The authors make 1 assumption that may not be justified, and should be clarified for readers since the resulting cost analyses would be strongly influenced. The issue is the assumed average weight of patients used in the RSV immune globulin (RSV-IGIV and palivizumab) cost analysis. In the prior RSV-IGIV and palivizumab randomized clinical trials, the mean weight of patients in control and treatment groups ranged from 4.5 to 4.9 kg2,3; however, in the Rochester report, a mean weight of 3.5 kg was assumed.1 Since the cost of prophylaxis of each patient is directly related to patient weight, this assumption would appear to result in a 30% to 40% underestimation of the actual "costs of prophylaxis" for all groups presented in Table 2 of the article. Additionally, the relationship of "cost to prevent 1 hospitalization" is not proportional to this value and would result in an even larger cost to prevent 1 hospitalization than presented in Table 3. Similar assumption effects on cost analyses have been noted previously, related to reduction in palivizumab doses required for adequate prophylaxis.4 As an example of the above concern, if an average patient weight of 4.8 kg is used (mean weight of the palivizumab group in the IMpact study) rather than 3.5 kg, the prophylaxis costs to administer palivizumab to the total group of 1029 patients becomes $3 910 591 (a 37% increase compared with the original analysis of $2 854 444). The net cost of prophylaxis then becomes $3 435 118 (the total prophylaxis charges [$3 910 591] minus the hospital costs avoided [0.55 × $864 497], or [$3 910 591-$475 473]).The net cost of prophylaxis for an individual patient becomes $3338 (3 435, 118/1029) and the cost to avoid a single hospitalization (number needed to treat = 16.6) becomes $55 410 (a 47% increase compared with the original report of $37 612). Similar underestimates would also exist in subgroup analyses. Could the authors clarify why the mean patient weight of 3.5 kg was chosen for all groups? In another cost analysis of palivizumab, Joffe et al5 utilized a weight similar to that reported in the IMpact study. Patient weight at the time of prophylaxis is a very important and perhaps underappreciated factor in cost analyses of RSV immune globulin products. References 1. Stevens TPSinkin RAHall CBManiscalco WMMcConnochie KM Respiratory syncytial vires and premature infants born at 32 weeks' gestation or earlier: hospitalization and economic implications of prophylaxis. Arch Pediatr Adolesc Med. 2000;15455- 61Google Scholar 2. The PREVENT Study Group, Reduction of respiratory syncytial virus hospitalization among premature infants and infants with bronchopulmonary dysplasia using respiratory syncytial vires immune globulin prophylaxis. Pediatrics. 1997;9993- 99Google ScholarCrossref 3. The IMpact-RSV Study Group, Palivizumab, a humanized respiratory syncytial virus monoclonal antibody, reduces hospitalization from respiratory syncytial virus infection in high-risk infants. Pediatrics. 1998;102531- 537Google ScholarCrossref 4. Moler FW RSV immune globulin prophylaxis: is an ounce of prevention worth a pound of cure [commentary]? Pediatrics. 1999;104559- 560Google ScholarCrossref 5. Joffe SRay GTEscobar GJ et al. Cost-effectiveness of respiratory syncytial virus prophylaxis among preterm infants. Pediatrics. 1999;104419- 427Google ScholarCrossref

Journal

Archives of Pediatrics & Adolescent MedicineAmerican Medical Association

Published: Feb 1, 2001

Keywords: immunoglobulins,palivizumab,respiratory syncytial virus immune globulin intravenous,impact trial,newborn,respiratory syncytial viruses,cost effectiveness

References