Cost-effectiveness of respiratory syncytial virus prophylaxis in premature infants less than 32 weeks gestational age in Turkey.

The main aim of this study was to evaluate the cost-effectiveness of RSV prophylaxis with palivizumab in Turkey, by comparing hospitalization rates and costs as well as results of risk analyses in preterm infants who were treated either with palivizumab or conservatively. The retrospective nature of the study significantly limits the authors’ ability to gauge the magnitude of the baseline risk of RSV-related hospitalization and the true impact of prophylaxis with palivizumab. Several biases were transparent at the inception of the study: the fundamental lack of a precise definition for an RSV-related hospitalization based on specific diagnostic tests, failure to establish parental contact in order to assess if patients were admitted to other institutions during the study period, lack of a description of the hospital network, which may pose a referral-filter bias, absence of a defined strategy to ensure all hospitalizations were captured, and failure to cite reasons for refusal of prophylaxis, which could profoundly influence the outcome relative to an infant’s demographic and environmental risk for acquiring RSV infection inclusive of the parents’ socioeconomic status. The control group in the study comprised infants whose parents refused prophylaxis, and this may include poor-risk or non-compliant patients or infants with extraneous characteristics that may adversely influence the outcome of interest. The overall convenient sample size To the Editor,