Anna Banerji1, Kaspar Ng1, Theo J Moraes1, Vladimir Panzov1, Joan Robinson1, Bonita E Lee1. 1. Li Ka Shing Knowledge Institute (Banerji), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Banerji), University of Toronto, Toronto, Ont.; Department of Pediatrics (Ng), University of Calgary, Calgary, Alta.; Hospital for Sick Children (Moraes); Applied Health Research Centre (Panzov), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Stollery Children's Hospital (Robinson) and Department of Pediatrics (Lee), Faculty of Medicine, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta.
Abstract
BACKGROUND: Hospital admissions for respiratory syncytial virus infection result in large health expenditures for Inuit infants. Palivizumab has been shown to be highly effective in reducing such admissions in preterm Inuit infants. We performed a cost-effectiveness analysis estimating the incremental cost-effectiveness ratio (ICER) for palivizumab prophylaxis per admission related to respiratory syncytial virus avoided in healthy term infants across the Canadian Arctic. METHODS: We compared universal palivizumab prophylaxis in term infants less than 6 months of age to no prophylaxis in 8 Arctic regions: the Northwest Territories, Nunavut, Nunavut without Iqaluit, the 3 subregions of Nunavut (Kitikmeot, Kivalliq and Qikiqtaaluk), the Qikiqtaaluk Region without Iqaluit, and Nunavik (northern Quebec). Costs were acquired from the territorial governments, hospitals and contracted agencies. The perspective is that of the public payer, with a 6-month timeline. In scenario A, universal prophylaxis was provided until the end of the respiratory syncytial virus season, and in scenario B, infants received prophylaxis until 5 months of age. The ICERs of scenario A were compared with those of scenario B. RESULTS: Under scenario A, the cost per admission avoided was as high as $546 115 in the Northwest Territories, compared with a cost savings of $36 145 in the Kitikmeot Region. Under scenario B, the ICER showed cost savings of $48 549 in the Kitikmeot Region and $2731 in the Kivalliq Region, with low ICERs in Nunavik of $15 601. INTERPRETATION: Considerable cost savings were found for the Kitikmeot Region with universal palivizumab prophylaxis in term infants with both scenarios, whereas cost savings were found for the Kivalliq Region with scenario B. Stopping prophylaxis at 5 months of age was a more cost-effective strategy in all regions except the Kitikmeot Region. Nunavik had low ICERs, and prophylaxis should be considered for this region.
BACKGROUND: Hospital admissions for respiratory syncytial virus infection result in large health expenditures for Inuit infants. Palivizumab has been shown to be highly effective in reducing such admissions in preterm Inuit infants. We performed a cost-effectiveness analysis estimating the incremental cost-effectiveness ratio (ICER) for palivizumab prophylaxis per admission related to respiratory syncytial virus avoided in healthy term infants across the Canadian Arctic. METHODS: We compared universal palivizumab prophylaxis in term infants less than 6 months of age to no prophylaxis in 8 Arctic regions: the Northwest Territories, Nunavut, Nunavut without Iqaluit, the 3 subregions of Nunavut (Kitikmeot, Kivalliq and Qikiqtaaluk), the Qikiqtaaluk Region without Iqaluit, and Nunavik (northern Quebec). Costs were acquired from the territorial governments, hospitals and contracted agencies. The perspective is that of the public payer, with a 6-month timeline. In scenario A, universal prophylaxis was provided until the end of the respiratory syncytial virus season, and in scenario B, infants received prophylaxis until 5 months of age. The ICERs of scenario A were compared with those of scenario B. RESULTS: Under scenario A, the cost per admission avoided was as high as $546 115 in the Northwest Territories, compared with a cost savings of $36 145 in the Kitikmeot Region. Under scenario B, the ICER showed cost savings of $48 549 in the Kitikmeot Region and $2731 in the Kivalliq Region, with low ICERs in Nunavik of $15 601. INTERPRETATION: Considerable cost savings were found for the Kitikmeot Region with universal palivizumab prophylaxis in term infants with both scenarios, whereas cost savings were found for the Kivalliq Region with scenario B. Stopping prophylaxis at 5 months of age was a more cost-effective strategy in all regions except the Kitikmeot Region. Nunavik had low ICERs, and prophylaxis should be considered for this region.
Authors: Anna Banerji; David Greenberg; Laura Forsberg White; W Alexander Macdonald; Audrey Saxton; Eva Thomas; Douglas Sage; Muhammad Mamdani; Krista L Lanctôt; James B Mahony; Mia Dingle; Ann Roberts Journal: Pediatr Infect Dis J Date: 2009-08 Impact factor: 2.129
Authors: Xavier Carbonell-Estrany; John R Fullarton; Barry S Rodgers-Gray; Katherine L Gooch; Pamela G Vo; Jose Figueras-Aloy Journal: J Matern Fetal Neonatal Med Date: 2014-08-14
Authors: Carole A Reeve; John S Whitehall; Petra G Buettner; Robert Norton; David M Reeve; Fleur Francis Journal: J Paediatr Child Health Date: 2006-05 Impact factor: 1.954
Authors: Anna Banerji; Vladimir Panzov; Michael Young; Bonita E Lee; Muhammad Mamdani; B Louise Giles; Marguerite Dennis; Johanne Morel; Danny Bisson; Bosco A Paes; Charles Hui; Jim Mahony Journal: Can Respir J Date: 2013-12-23 Impact factor: 2.409
Authors: Anna Banerji; Krista L Lanctôt; Bosco A Paes; Shababa T Masoud; Derrick Y Tam; W Alexander Macdonald; Ann Roberts Journal: Pediatr Infect Dis J Date: 2009-08 Impact factor: 2.129
Authors: Anna Banerji; Val Panzov; Joan Robinson; Michael Young; Kaspar Ng; Muhammad Mamdani Journal: Int J Circumpolar Health Date: 2013-08-05 Impact factor: 1.228
Authors: Lindsay A Wilson; Barry Pakes; Malia S Q Murphy; Katherine M Atkinson; Cameron Bell; Kumanan Wilson Journal: Int J Circumpolar Health Date: 2017 Impact factor: 1.228
Authors: Shokoofeh Nourbakhsh; Affan Shoukat; Kevin Zhang; Guillaume Poliquin; Donna Halperin; Holden Sheffield; Scott A Halperin; Joanne M Langley; Seyed M Moghadas Journal: EClinicalMedicine Date: 2021-09-24