During the 1-year follow-up, the mean total RSV prophylaxis costs per patient were 4717 for the RSV prevention group and 0 for the placebo group. patient against additional cost of 472 compared to no prophylaxis (ICER 214,748/QALY). The ICER falls below a threshold of 80,000 per QALY when RSV prophylaxis cost would be lowered from 928 (baseline) to 406 per unit. At a unit cost of 97, RSV prophylaxis would be cost saving. (SD 0.01)Korsten et al.RSV prophylaxis group?Recurrent wheezing, no RSV hospitalisationb 0.190.15C0.24 (SD 0.02)Blanken?et al.?Recurrent wheezing, RSV hospitalisationb 0.550.41C0.68 (SD 0.05)Blanken?RSV hospitalisation, given high risk0.1260.095C0.158 (SD 0.01)Korsten?PICU, given hospitalisationc 0.0880.07C0.11 (SD 0.01)Korsten?Mortality, given PICU admissionc 0.010.008C0.013 (SD 0.001)SupplementPlacebo group?Recurrent wheezing, no RSV hospitalisation0.190.15C0.24 (SD 0.02)Blanken?Recurrent wheezing, RSV hospitalisation0.550.41C0.68 (SD 0.05)Blanken?RSV hospitalisation, given low risk0.0340.026C0.043 (SD 0.005)Korsten?PICU, given hospitalisation0.0880.07C0.11 (SD 0.01)KorstenStandard care?Recurrent wheezing, no RSV hospitalisation0.190.15C0.24 (SD 0.02)Blanken?Recurrent wheezing, RSV hospitalisation0.550.41C0.68 (SD 0.05)Blanken?RSV Ceforanide hospitalisation0.0440.033C0.055 (SD 0.005)Korsten?PICU, given hospitalisation0.0880.07C0.11 (SD 0.01)KorstenUtility (positive)/disutility (negative)?No RSV hospitalisation, baseline0.950.71C1.00Gamma (SD 0.1)Greenough?et al.?RSV hospitalisation??0.07??0.05C?-0.09Gamma (SD 0.01)Greenough?PICU admission Ceforanide ??0.15??0.17C?-0.28Gamma (SD 0.02)Jones?et al.?Wheezing, QALY reduction??0.08??0.06C?-0.1Gamma (SD 0.01)RIVMProphylaxis effectiveness?Reduction of RSV hospitalisation0.820.62C1.03 (SD 0.08)Blanken?Reduction of recurrent wheezing0.470.35C0.59 (SD 0.05)Blanken Open in a separate window sensitivity analysis range, standard deviation aUnivariate sensitivity analysis ranges were derived by increasing and decreasing baseline values by 25% bRecurrent wheezing following RSV GP visit in the RSV prophylaxis group was assumed equal to recurrent wheezing following RSV GP visit in the placebo group because the trial data suggested an inconsistent probability of 1.0 following RSV GP visit in the RSV prophylaxis group ( em n /em ?=?2) cPotential utility loss and costs due to PICU admission and mortality were included in all RSV hospitalisation based on the probability of PICU admission and mortality following RSV hospitalisation Follow-up In the MAKI trial, parents recorded airway Rabbit Polyclonal to RPC3 symptoms, doctor visits, hospitalisations and the use of airway medication in a daily log until their infant was 1?year of age. General practitioners (GPs) recorded number of GP visits and number of prescriptions of short-acting beta agonist as relief medication (first-choice test treatment Dutch College of GPs) . In this model, we included recurrent wheeze in the first year of life. Recurrent wheeze was defined as three or more episodes of wheezing during the first year of life. The number of hospitalisations for laboratory-proven RSV infection was assessed during the first year of life in both the MAKI trial and the RISK study. Measurement of effectiveness The efficacy of RSV prophylaxis with palivizumab in reducing hospital admission in infants born at 32C35?weeks gestational age was set at 82% (95% CI 18C157%) reduction as retrieved from two randomised clinical trials [8, 39]. Additionally, the MAKI trial provided the efficacy of RSV prophylaxis in reducing recurrent wheeze which was set a 47% reduction . High-risk group identification For the use of targeted RSV prophylaxis, we considered 11% of the palivizumab group as high risk, with a cut-off of a ?10% hospitalisation risk, following the proportion of the RSV prediction rule paper . The MAKI trial data did not permit us to do individualised prediction because of missing baseline data for the prediction rule and the low percentage of hospitalisations . Cost estimates We valued the use of health care resources for both treatment groups in the MAKI trial Ceforanide with Dutch reference prices and calculated total costs from the total quantity of health care resources consumed and the unit cost of those resources . Costs of medication were obtained from the Dutch Formulary, including a Ceforanide pharmacist fee for each subscription. Use of bronchodilators (short-acting beta agonist, first choice salbutamol/albuterol) was calculated for a trial course of 2?weeks, followed by symptom relief treatment based on reported symptoms in the diary, according to national asthma guidelines for this age group . Over the counter drugs were not measured in the trial and not included in this model because of a lack of reliable data in this population. Used health care resources did not include administration cost for RSV prophylaxis as this is a free of charge service as part of palivizumab reimbursement in the Netherlands. In case of PICU admission, ambulance transfer was taken into account because PICU admissions in the Netherlands generally occur after.