According to the findings of this Health Technology Assessment report, respiratory syncytial virus (RSV) prophylaxis with palivizumab is not cost-effective based on the current UK threshold when used unselectively in children with chronic lung disease (CLD), congenital heart disease (CHD), or in children without these conditions.  There are some subgroups however in which its use may be cost-effective.  The authors note that the quality of the studies was poor and the true cost-effectiveness may vary considerably from their estimates.

RSV is a seasonal infectious disease that can lead to hospitalisation in infants and young children, especially in those who are premature or who have CLD or CHD.  The monoclonal antibody palivizumab is intended to provide passive immunity against RSV and is licensed for the prevention of serious lower respiratory tract infection caused by RSV in children at high risk.  The purpose of this systematic review and economic modelling study was to determine the cost-effectiveness of using palivizumab in different subgroups of children.

The review identified 13 studies suitable for inclusion.  Analysis of 16,128 different subgroups showed that palivizumab prophylaxis may be cost-effectiveness (based on willingness-to-pay threshold of £30,000 per QALY) for some subgroups, for example:

• Pre-term children (born at <24 weeks gestational age) without CLD or CHD who were <6 weeks at the start of the RSV season and who had at least two other risk factors
• Children with CLD aged <6 months at the start of the RSV season who were born at ≤28 weeks
• Children with acyanotic and cyanotic CHD aged <6 months at the start of the RSV season who were born at ≤28 weeks

The authors summarise that the cost-effective subgroups for children who had no CLD or CHD must contain at least two other risk factors apart from gestational age and birth age.  The cost-effective subgroups for children who had CLD or CHD do not necessarily need to have any other risk factors. Future research should be directed towards conducting much larger, better powered and better reported studies to derive better estimates of the risk factor effect sizes.