Respiratory syncytial virus prophylaxis in preterm infants: a cost-effectiveness study from Turkey

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 <= 28(6/7) 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 <= 28(6/7) 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 <= 28(6/7) weeks of gestation with or without BPD.