[Potential impact and cost-efficacy of bronchiolitis prophylaxis with palivizumab in preterm infants with a gestational age of less than 33 weeks].

INTRODUCTION

Respiratory syncytial virus (RSV) is the main cause of bronchiolitis in children aged less than 2 years. The effectiveness of palivizumab has recently been reported in several clinical trials.

OBJECTIVE

The aim of this study was to evaluate the hypothetical impact of a treatment strategy using palivizumab for the prevention of bronchiolitis in premature infants.

METHODS

Neonates born in our hospital between January 1995 and December 1998 who were admitted for bronchiolitis were included. Using information from the Impact-RSV study, the effects and impact of different cut-off points in the gestational age of the study group were measured. Cost-effectiveness analysis included the cost of hospitalization as well as the direct cost of palivizumab prescriptions.

RESULTS

Of 7,766 newborn infants, 56 had a gestational age of < or =32 weeks. Of these, bronchiolitis was diagnosed in eight infants (14.28%), and RSV was isolated in seven (14.28%). After hypothetical prophylaxis in premature infants the best results were obtained in the group with a gestational age of 30 weeks. In this group the relative risk of admission for bronchiolitis was 12.1 (95% CI: 4.8-30.5) and treatment would be required in nine infants to avoid one admission (cost Euros 12,915), with a cost 3.8 times greater than the current cost, without prophylaxis.

CONCLUSIONS

Measurement of the impact and cost-effectiveness analysis of palivizumab prophylaxis provides a useful method for determining recommendations for the prevention of bronchiolitis in premature infants.