COST-BENEFIT ANALYSIS OF PROPHYLAXIS WITH PALIVIZUMAB IN PRETERM INFANTS ON THE PREVENTION OF RESPIRATORY SYNCYTIAL VIRUS INFECTIONS
Introduction: Syncytial respiratory virus (RSV) is the main cause of lower respiratory tract infections in babies and is responsible for infecting 68% of infants during the first year of life. The drug Palivizumab is a monoclonal antibody used as prophylactic against the RSV. To prevent infections by the virus and reduce its morbidity, approximately 50 countries have adopted protocols for the use of the drug, but there is no consensus on its effectiveness and the cost-benefit ratio, due to the high price of the drug. Objective: This article is an integrative review about the cost-benefit of prophylaxis, with the objective of comparing the data obtained from recent studies and reaching an objective and impartial conclusion. Methodology: The study was elaborated between July and August 2020. Articles in Portuguese and English were searched in the SCIELO, MEDLINE and PUBMED databases, published in the last 5 years, using the Boolean operators: "palivizumab" AND "randomized controlled trial "; "palivizumab" AND "cohort study"; "palivizumab" AND "observational study". The selected articles were submitted to a full analysis of their contents, and the results were cataloged in a Microsoft Excel® 2019 spreadsheet. All monetary values were converted into US dollars and adjusted for inflation to standardize the sample. Results: Of the analyzed articles, 3 reached a negative cost-benefit conclusion and 2 reached a positive ratio. Using the ICER parameter to quantify cost-benefit, the data obtained ranged from $ 24,439/QALY to $ 261,316/QALY in relation to conventional treatments and other protocols. Only one study concluded that prophylaxis results in cost savings, while another concluded with a favorable opinion as the ICER parameter remained within acceptable values. Conclusion: The wide variation in the data can be largely attributed to the different inclusion protocols adopted and the different methodologies used in the studies. The variety of conclusions reflects the lack of consensus on the topic in the scientific community, but the analysis of the results allows us to affirm that the cost-benefit of the treatment is a relative issue. Using ICER cost-benefit benchmarks published by sources linked to government agencies, the range found, $ 24,439/QALY to $ 261,316/QALY, establishes the use of prophylaxis as possibly acceptable in developed countries, but highly inefficient in middle-income countries like Brazil, even based on the most optimistic data.
Key-words: palivizumab; syncytial respiratory virus; preterm infants; cost-benefit.
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