Population-based Respiratory Syncytial Virus Hospitalization Disease Burden and Cost Effectiveness of Palivizumab Prophylaxis in Infants with Hemodynamically Significant Congenital Heart Diseases

Abstract Background Infants with hemodynamically significant congenital heart disease (HsCHD) are at risk of respiratory syncytial virus hospitalization (RSVh) and Palivizumab has been shown to be effective in preventing RSVh in regions with a distinct RSV season. However, the incidence of RSVh in HsCHD patients and the cost-effectiveness of Palivizumab in regions with year-round RSV activity is largely unknown. Methods All HsCHD patients < 12 months of age referred to the only tertiary pediatric cardiology center in Hong Kong during 1 Jan 2014 to 31 Dec 2016 were included. RSVh rate, Palivizumab efficacy and cost-effectiveness were assessed using a 5 or 6 monthly dose regimen starting from first hospital discharge. Results Twenty-six RSVh (11%) were identified out of 236 HsCHD patients. 222 patients were included for further analysis of Palivizumab efficacy and cost-effectiveness. The number needed to treat to prevent RSVh using 5 and 6 dose regimen was 54.9 and 38, respectively, with a wide year-to-year variation from 25 to 166.6. RSVh cost without Palivizumab was $379,436; while palivizumab program cost for 5 and 6 dose were $727,481 and $849,888 respectively. Incremental cost-effective ratio per hospital admission prevented was $85,937 and $80,419 for 5 and 6 dose regimen, respectively, with a wide year-to-year variation from $40,410 to $277,367. Conclusion This is one of the first population-based studies in infants with HsCHD demonstrating a high RSVh burden in a region with round the year circulation of RSV. Palivizumab program was assessed to be not cost-effective in preventing RSVh in such a locality.