Palivizumab has been shown to reduce RSV associated hospitalization compared with placebo, as determined by one RCT of premature children (<32 weeks gestational age, and 32 to 35 weeks gestational age), some of whom had bronchopulmonary dysplasia. A second RCT demonstrated reductions in RSV-associated hospitalization in children with hemodynamically significant congenital heart disease. These are the only RCTs examining the efficacy of palivizumab in these groups of children.
No Canadian economic evaluations of palivizumab were found, although the costs of palivizumab were reported in a Canadian study. A recent review states that the cost-effectiveness of palivizumab is difficult to assess because of the lack of high quality cost-benefit analyses. Societal costs such as the loss of parents wages were not always considered in economic analyses, and therefore, a true determination of cost-effectiveness is challenging.
The CPS recommends that palivizumab be considered for children at the highest risk, such as children with BPD, and children born at 32 weeks gestation.
Children born between 32 weeks and 35 weeks gestational age may not be at high risk for RSV hospitalization, and considering the costs of palivizumab, these infants should be assessed for other risk factors because palivizumab may be unnecessary.
Palivizumab is an expensive option, but it has been shown to be effective for certain groups of infants and children.