Assessing Variation in the Cost of Palivizumab for Respiratory Syncytial Virus Prevention in Preterm Infants

Abstract

BackgroundThe variability in cost of palivizumab treatment, indicated for prevention of respiratory syncytial virus (RSV) infections in high-risk infants, has not been robustly estimated in prior studies. This study aimed to determine the cost variations of palivizumab from a US payer perspective for otherwise healthy preterm infants born 29–35 weeks gestational age (wGA) using infant characteristics and applied dosing regimens.MethodsFenton Growth Charts were merged with World Health Organization Child Growth Standards to estimate preterm infant growth patterns. The merged growth chart was applied to infants who received palivizumab from a prospective, observational registry to determine future body weight using each infant’s wGA and birth weight. Using quarter 3 (Q3) 2016–Q2 2017 vial cost, treatment costs at monthly dosing intervals were estimated using expected weights and averaged by age to derive expected mean 2016–2017 RSV seasonal costs per infant under various dosing scenarios.ResultsGiven different dosing scenarios (two to five doses), birth month, and growth patterns for preterm infants 29–35 wGA, the estimated average 2016–2017 seasonal cost of palivizumab treatment ranged from $3221 to $12,568. Outpatient-only cost (excluding first dose at hospital discharge) ranged from $1733 to $11,862. The main drivers of costs were dosing regimen (74% of variance), dosing interacted with birth month (17%), and wGA (6%).ConclusionThe considerable variability in the average cost of palivizumab treatment for preterm infants is driven by choice of dosing regimen, wGA, and birth month. Therefore, when estimating the cost of palivizumab, it is important to consider both infant characteristics at each dose and potential dosing regimens.Electronic supplementary materialThe online version of this article (doi:10.1007/s41669-017-0042-3) contains supplementary material, which is available to authorized users.

Structure of the Respiratory Syncytial Virus Polymerase Complex

“…Currently, the only clinical intervention for RSV is passive prophylaxis with the monoclonal antibody Synagis, which reduces RSV-related hospitalization (The IMpact-RSV Study Group, 1998). However, the high cost and moderate efficacy of Synagis restrict its use to high-risk infants in developed regions of the world (Homaira et al, 2014;Shahabi et al, 2018;The IMpact-RSV Study Group, 1998). Thus, there is great interest in developing more effective therapeutic agents for RSV, including small-molecule antivirals.…”

Transient opening of trimeric prefusion RSV F proteins

“…In the United States, for example, it is estimated that 652 million dollars were spent in 2000 alone on RSV-related medical costs 3 . Although prophylaxis with the monoclonal antibody palivizumab reduces the risk of hospitalization associated with RSV, it must be delivered intravenously multiple times per RSV season and has modest efficacy, preventing its use in developing regions 4,5 .…”

Palivizumab Prophylaxis for Respiratory Syncytial Virus: Examining the Evidence Around Value

“…Second, the cost of palivizumab prophylaxis is based on infant weight, which is determined partly by the gestational age at birth, as well as the chronologic age. Smaller infants are treated with smaller doses of palivizumab, which lowers the costs of prophylaxis in younger or more premature infants [28]. These cost trends move in opposite directions, and there are potentially certain high-risk groups in which the costliest hospitalizations could be prevented with lowest-cost prophylaxis, creating a possible “sweet spot” for value.…”