加拿大对所有婴儿实施延长半衰期单克隆抗体与呼吸道合胞病毒预防标准护理的卫生经济评估

Thomas Shin, Jason K.H. Lee, Alexia Kieffer, Michael Greenberg, Jianhong Wu
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摘要

呼吸道合胞病毒(RSV)是一种传染性极强的病毒,婴幼儿尤其容易感染这种病毒,导致严重的下呼吸道疾病(LRTI)。Nirsevimab 是一种半衰期较长的单克隆抗体,最近在加拿大被批准作为预防 RSV LRTI 的被动免疫干预措施。我们利用静态决策树模型确定了在加拿大婴儿中使用 nirsevimab 的成本效益,与当前的标准疗法(帕利珠单抗用于早产儿和患有特定慢性病的婴儿)进行了比较,并根据公认的支付意愿(WTP)阈值得出了每剂量的最佳价格(PPD)。我们计算了一个 RSV 流行季的各种健康结果(包括住院、重症监护室和机械通气)和医疗成本,并在第二个流行季对三类婴儿(符合帕利珠单抗条件的婴儿、早产儿和足月儿)进行了必要的后续预防。所有与健康相关的参数和成本均根据加拿大的环境进行了调整。与只有高危婴儿群体接受尼舍单抗治疗的方案相比,基础方案(在婴儿感染 RSV 的第一个季节对所有婴儿使用尼舍单抗)与标准护理相比最具成本效益:采用所有方案的平均成本计算数据假设,在 40,000 美元/QALY WTP 临界值下,PPD 为 692 美元。与标准护理相比,基础方案可避免 18,249 例 RSV 相关健康后果(减少 9.96%)。贴现率、每月 RSV 感染分布、尼舍维单抗对足月儿的覆盖率以及帕利珠单抗成本的变化对模型的影响最大。对所有婴儿使用尼舍单抗进行被动免疫可显著降低加拿大与 RSV 相关的健康和经济负担。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A Health Economic Evaluation for Implementing an Extended Half-life Monoclonal Antibody for All Infants vs. Standard Care for Respiratory Syncytial Virus Prophylaxis in Canada
Respiratory syncytial virus (RSV) is a highly infectious virus, and infants and young children are particularly vulnerable to its progression to severe lower respiratory tract illness (LRTI). Nirsevimab, an extended half-life monoclonal antibody, was recently approved in Canada as a passive immunization intervention for the prevention of RSV LRTI. A static decision tree model was utilized to determine the cost-effectiveness of nirsevimab in Canadian infants compared to current standard of care (palivizumab for infants born preterm, and with specific chronic conditions) and generate an optimal price per dose (PPD) at accepted willingness-to-pay (WTP) thresholds. Various health outcomes (including hospitalization, ICU, and mechanical ventilation) and healthcare costs were calculated over one RSV season, with any necessary follow-up prophylaxis in the second season for three infant categories (palivizumab-eligible, preterm, and term). All health-related parameters and costs were tailored to the Canadian environment. Compared to scenarios where only at-risk segments of the infant population received nirsevimab, the base case (administering nirsevimab to all infants in their first RSV season) was the most cost-effective versus standard care: the PPD was $692 at a $40,000/QALY WTP threshold, using average costing data assumptions across all scenarios. Compared to standard care, the base case scenario could avoid 18,249 RSV-related health outcomes (reduction of 9.96%). Variations in discount rate, distribution of monthly RSV infections, nirsevimab coverage rate for infants born at term, and palivizumab cost had the most significant model impact. Passive immunization of all infants with nirsevimab can significantly reduce RSV-related health and economic burden across Canada.
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