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Background <p>The International Risk Scoring Tool (IRST) comprises three risk factors (age relative to the respiratory syncytial virus [RSV] season; household and/or maternal smoking; siblings and/or daycare attendance) and enables the cost-effective targeting of palivizumab to infants born at 32–35 weeks’ gestational age (wGA) at greatest risk of related hospitalization (RSVH). This study provides the first evaluation of IRST-guided RSV prophylaxis in Colombia.</p> Methods <p>The IRST (with wGA substituted for chronological age as RSV is endemic in Colombia) plus other risk factors were assessed using data from 81 infants born 32–35 wGA with RSVH and 49 gestational- and age-matched controls. A cost-utility model comparing IRST-guided palivizumab versus no prophylaxis from the healthcare provider perspective was then adapted using Colombian costs and data (5% discounting). Infants could experience either RSVH, emergency room medically-attended, RSV infection, or remain uninfected/non-attended, with possible long-term respiratory morbidity up to 18 years of age over a lifetime time horizon.</p> Results <p>The most predictive combination of risk factors was the IRST plus mixed breast and formula feeding and maternal education (area under the receiver operating characteristic curve = 0.823). For infants assessed at moderate- and high-risk of RSVH, the cost/quality-adjusted life year (QALY) was COP20,225,126 (USD4,752). Probabilistic sensitivity analyses resulted in a mean of COP22,193,734/QALY (USD5,214/QALY), with a 61.1% probability of palivizumab being cost-effective at a COP28,193,734 (USD6,624; 2022 gross domestic product/capita) willingness-to-pay threshold.</p> Conclusions <p>Palivizumab prophylaxis of 32–35 wGA infants at moderate- and high-risk of RSVH, identified using the Colombian-adapted IRST, proved to be cost-effective versus no intervention.</p>

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Clinical and economic evaluation of risk factor guided respiratory syncytial virus prophylaxis in Colombian preterm infants

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月27日

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  • Carlos E. Rodriguez-Martinez,
  • Jaime Ordonez,
  • Xavier Carbonell-Estrany,
  • John Fullarton,
  • Ian Keary,
  • Barry Rodgers-Gray,
  • Ivonne D’Apremont,
  • Daniel E. Noyola,
  • Paulo Andre Ribeiro,
  • Renato T. Stein,
  • Nestor Vain,
  • Jean-Eric Tarride,
  • Bosco Paes

摘要

Background

The International Risk Scoring Tool (IRST) comprises three risk factors (age relative to the respiratory syncytial virus [RSV] season; household and/or maternal smoking; siblings and/or daycare attendance) and enables the cost-effective targeting of palivizumab to infants born at 32–35 weeks’ gestational age (wGA) at greatest risk of related hospitalization (RSVH). This study provides the first evaluation of IRST-guided RSV prophylaxis in Colombia.

Methods

The IRST (with wGA substituted for chronological age as RSV is endemic in Colombia) plus other risk factors were assessed using data from 81 infants born 32–35 wGA with RSVH and 49 gestational- and age-matched controls. A cost-utility model comparing IRST-guided palivizumab versus no prophylaxis from the healthcare provider perspective was then adapted using Colombian costs and data (5% discounting). Infants could experience either RSVH, emergency room medically-attended, RSV infection, or remain uninfected/non-attended, with possible long-term respiratory morbidity up to 18 years of age over a lifetime time horizon.

Results

The most predictive combination of risk factors was the IRST plus mixed breast and formula feeding and maternal education (area under the receiver operating characteristic curve = 0.823). For infants assessed at moderate- and high-risk of RSVH, the cost/quality-adjusted life year (QALY) was COP20,225,126 (USD4,752). Probabilistic sensitivity analyses resulted in a mean of COP22,193,734/QALY (USD5,214/QALY), with a 61.1% probability of palivizumab being cost-effective at a COP28,193,734 (USD6,624; 2022 gross domestic product/capita) willingness-to-pay threshold.

Conclusions

Palivizumab prophylaxis of 32–35 wGA infants at moderate- and high-risk of RSVH, identified using the Colombian-adapted IRST, proved to be cost-effective versus no intervention.