Grant: Travel Awards - Institute Community Support

Introduction: Palivizumab (PMB) is a preventative therapeutic (prophylaxis) given to infants for respiratory syncytial virus (RSV). However, due to its high drug costs, the value of this intervention is unclear. The objective of this study was to conduct a systematic review on the value of providing PMB prophylaxis compared to no prophylaxis in infants under 24 months of age. Methods: We searched three databases: Medline, Embase, and the Cochrane Library and included economic evaluations conducted from Organization for Economic Co-operation and Development (OECD) countries, published between 2000 and 2018. Quality appraisal was completed using the Joanna Briggs Institute checklist. Costs were adjusted and inflated to 2017 United States (US) dollars. We categorized and reported the value of PMB based on study characteristics, and RSV risk factors (e.g. premature birth, lung disease, and heart disease). Results: We identified 28 economic studies that met our eligibility criteria. Most studies were conducted in the US (n=6), and Canada (n=5). Studies were considered high quality based on the checklist criteria used. PMB prophylaxis ranged from being a program that was cost saving and provided health benefits, to costing an additional $2,526,203 per quality-adjusted life year (QALY), depending on the study setting, target population and risk factors. From the healthcare payer's perspective, PMB for infants born prematurely at 29 to 35 weeks gestational age cost an additional $5,188 to $791,265/QALY, with 90% of cost-effectiveness estimates below a $50,000/QALY threshold. Influential parameters to the value of PMB reported were: reduction in RSV hospitalization rates, PMB cost, and the discounting rate. Conclusions: Palivizumab as a RSV prophylaxis was considered to have good value in specific subgroups: infants with lung disease or heart disease, infants from specific remote communities, and preterm infants with and without lung complications.