BACKGROUND: Respiratory syncytial virus (RSV) is a common pathogen that is the 
leading cause of lower respiratory tract infections in young children. High-risk 
children are at risk of severe infection, which may require hospitalisation. RSV 
is also associated with a high risk for respiratory morbidity and mortality, 
which may have long-term clinical and economic consequences.
OBJECTIVE: To assess the cost effectiveness of palivizumab, a humanised 
monoclonal antibody, used as prevention against severe respiratory syncytial 
virus (RSV) infection requiring hospitalisation, in the indication of preterm 
infants and infants with preterm/bronchopulmonary dysplasia and in the second 
indication of children with congenital heart disease in the Dutch healthcare 
setting.
METHODS: A decision-tree model was used to estimate the cost effectiveness of 
palivizumab, used as a preventative treatment against severe respiratory 
syncytial virus (RSV) infection, in high-risk groups of children in the 
Netherlands. The analysis was based on a lifetime follow-up period in order to 
capture the impact of palivizumab on long-term morbidity and mortality resulting 
from an RSV infection. Data sources included published literature, the 
palivizumab pivotal trials, official price/tariff lists and national population 
statistics. The study was conducted from the perspective of society in the 
Netherlands.
RESULTS: The use of palivizumab results in undiscounted incremental 
cost-effectiveness ratios of €12,728/QALY and €4,256/QALY in 
preterm/bronchopulmonary dysplasia and congenital heart disease indications, 
respectively. Inclusion of indirect costs leads to even more favourable 
cost-effectiveness outcomes. The study is limited by a number of conservative 
assumptions. It was assumed that palivizumab only affects the occurrence of RSV 
hospitalisation and does not influence the severity of the RSV infection. 
Another assumption was that international clinical trial data and data on 
utilities could be applied to the Dutch healthcare setting.
CONCLUSION: Palivizumab provides cost-effective prophylaxis against RSV in 
high-risk infants. The use of palivizumab in these children results in positive 
short- and long-term health-economic benefits.