Original article Cost utility of palivizumab prophylaxis among pre-term infants in the United States: a national policy perspective

Objective: The cost-effectiveness of palivizumab has previously been reported among certain guideline-eligible, highrisk premature infants in Medicaid. Because guideline authorities base decisions on a national perspective, the economic model of palivizumab was adapted to include all infants, that is, public and privately insured patients (60% of palivizumab use is public, 40% is private). Methods: This study examined four groups of premature infants without chronic lung disease of prematurity or congenital heart disease: (1)532 weeks gestational age (wGA) and � 6 months chronologic age (CA); (2) 32–34 wGA, � 3 months CA, with 2009 American Academy of Pediatrics (AAP) risk factors (RFs); (3) 32– 35 wGA, � 6 months CA, with 2006 AAP RFs; and (4) 32–35 wGA, � 6 months CA, with � 1 RF. An average estimate was used between public and private payors for (1) background rates of respiratory syncytial virus hospitalization (RSV-H), (2) direct medical costs associated with RSV-H, and (3) cost of palivizumab. Incremental cost-effectiveness ratios (ICERs) are reported in cost per quality-adjusted life-year (QALY) gained. Sensitivity analyses were performed.