Prophylaxis against respiratory syncytial virus (RSV), varicella, and pneumococcal infections: Economic-based decision-making.

OBJECTIVE To compare costs and health benefits of three prophylactic interventions recommended by the American Academy of Pediatrics (AAP) and to help quantify the impact of illness and enhance the physicians' ability to make informed decisions. STUDY DESIGN Medline search was conducted of English-language cost-effectiveness studies of varicella and pneumococcal conjugate vaccination recommended for all healthy infants and of respiratory syncytial virus (RSV) prophylaxis with palivizumab (Synagis) for infants at high risk for severe RSV infection. Data were collected on cost-effectiveness, burden of illness, and efficacy and analyzed from the societal and payer perspective. Results were discounted by 5% and costs inflated to year 2002 dollars. RESULTS From the societal perspective, estimates of cost per life-years saved were money savings for varicella, 175,300 US dollars for pneumococcal conjugate vaccination, and 66,200 US dollars for palivizumab prophylaxis; from the payer perspective, estimates were 28,100, 338,400, and 66,400 US dollars, respectively. CONCLUSIONS Cost-effectiveness estimates for varicella and pneumococcal conjugate vaccination demonstrate that evaluating economic benefits from the societal rather than the payer perspective makes universal prophylaxis very financially attractive. By comparison, this same differential does not exist for the cost-effectiveness estimates of palivizumab from the societal and payer perspectives because its use is in a well-defined high-risk target population. From a societal perspective, prophylaxis is a rational public policy decision, although in target populations, incidence of serious illness and the primary cost components driving the cost offsets vary across prophylactic measures studied.