The Turkish Journal of Pediatrics
2012 , Vol 54 , Num 4
Respiratory syncytial virus prophylaxis in preterm infants: a cost-effectiveness study from Turkey
Division of Neonatology, 1Zekai Tahir Burak Maternity Training Hospital, and 2Etlik Zübeyde Hanım Maternity and
Women’s Health Academic and Research Hospital, and Departments of 3Biostatistics, and 4Pediatrics, Yıldırım Beyazıt
University, Faculty of Medicine, Ankara, Turkey. E-mail: dryekta@gmail.com
The main aim of this study was to evaluate the cost-effectiveness of respiratory
syncytial virus (RSV) prophylaxis with palivizumab in Turkey, by comparing
hospitalization rates and costs as well as results of risk analyses in preterm
infants who were treated either with palivizumab or conservatively. This
retrospective study was undertaken in two centers on infants born with a
gestational age of ≤32 weeks during the 2010-2011 seasons. Patients were
divided into two groups based on status of RSV prophylaxis. The records of
272 infants were included in the final analysis, 201 (73.9%) of which had
received palivizumab (Group 1), while 71 (26.1%) were not given any form
of RSV prophylaxis. The difference between groups in terms of demographic
characteristics and risk factors for RSV infection was statistically insignificant
(p>0.05). Thirteen patients (6.5%) in Group 1 and 5 patients (7%) in Group
2 were hospitalized for lower respiratory tract infections (LRTIs) (p>0.05). In
newborns born at ≤286/7 weeks of gestation, RSV prophylaxis with palivizumab
was associated with a 38.75% decrease in hospitalization rates due to LRTIs
compared to the untreated group (8% in the untreated group vs. 4.9% in
the palivizumab group; p=0.577). The hospitalization rate due to LRTIs for
infants in Group 1 born after 29-32 weeks of gestation was 7.5% compared
to a rate of 6.5% in Group 2, with a statistically insignificant difference
(p=0.828). In infants with bronchopulmonary dysplasia (BPD) born at ≤286/7
weeks of gestation, treatment with palivizumab was associated with a 39.1%
decrease in LRTI-related hospitalization rates (14.3% in the untreated group
vs. 8.7% in the palivizumab group; p=0.677). This clinical study is the first
of its kind from Turkey to evaluate the cost-effectiveness of palivizumab
treatment as prophylaxis against RSV infections in preterm infants, where
hospitalization rates and costs of patients treated with palivizumab were
compared with those of infants who were treated conservatively. Our study
results suggest that administration of palivizumab does not have any cost
benefit, regardless of gestational age. However, a reduction in hospitalization
rates in association with palivizumab treatment was observed in infants born
at ≤286/7 weeks of gestation with or without BPD.
Keywords :
cost-effectiveness, respiratory syncytial virus infections, palivizumab,
premature infants, hospitalization, Turkey.