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Table 5 Results of the scenario analyses, incremental costs, outcomes, and incremental cost-effectiveness ratios

From: Palivizumab in the prevention of severe respiratory syncytial virus infection in children with congenital heart disease; a novel cost-utility modeling study reflecting evidence-based clinical pathways in Spain

Scenario Incremental costs Incremental QALYs Incremental LYs ICER (QALYs) ICER (LYs)
Base case scenario € 1693 0.11 0.07 € 15,748 € 24,936
Model setting parameters
 Discount rate: 1.5% € 1610 0.14 0.10 € 11,252 € 16,005
 Discount rate: 5% € 1783 0.08 0.05 € 22,009 € 38,971
 Time horizon: 10 years € 1693 0.05 0.02 € 33,654 € 77,789
 Time Horizon: 30 years € 1693 0.09 0.05 € 19,307 € 36,405
Clinical parameters
 10% (relative) lower RSV-H rate € 1808 0.10 0.06 € 18,364 € 29,595
 Palivizumab efficacy (RSV-H) at lower 95% confidence interval limit € 1916 0.09 0.05 € 21,300 € 35,024
 Palivizumab efficacy (RSV-H) at upper 95% confidence interval limit € 1415 0.13 0.08 € 10,952 € 16,805
 Case fatality based on Wang et al. (3.72%) [54] € 1673 0.09 0.05 € 18,720 € 34,629
 Case fatality +1% higher in no prophylaxis group € 1721 0.13 0.10 € 12,841 € 17,825
 No general population background mortality in 1st year € 1572 0.11 0.07 € 14,133 € 23,155
 Allergic sensitization excluded € 1923 0.09 0.07 € 22,055 € 28,328
 All respiratory sequelae excluded € 2209 0.08 0.07 € 28,333 € 32,545
 Length of respiratory sequelae 6 years € 2020 0.09 0.07 € 23,512 € 29,764
 Length of respiratory sequelae 12 years € 1841 0.10 0.07 € 18,843 € 27,125
 Length of respiratory sequelae 24 years € 1569 0.12 0.07 € 13,574 € 23,118
 Length of respiratory sequelae: lifetime € 1094 0.15 0.07 € 7446 € 16,112
 Proportion of respiratory sequelae: +5% € 1584 0.11 0.07 € 14,054 € 23,344
 Proportion of respiratory sequelae: −5% € 1801 0.10 0.07 € 17,616 € 26,529
Utility parameters
 No utility decrement for RSV-H € 1693 0.11 0.07 € 15,947 € 24,936
 No utility decrement for allergy € 1693 0.09 0.07 € 19,414 € 24,936
 No utility decrement for asthma € 1693 0.10 0.07 € 17,224 € 24,936
Cost parameters
 Indirect costs associated with prophylaxis and hospitalization excluded € 1552 0.11 0.07 € 14,441 € 22,867
 Palivizumab cost: Proportions of 50 mg and 100 mg vial use equal to 0% and 100%, respectively € 1751 0.11 0.07 € 16,295 € 25,804
 Palivizumab cost: Proportion of 100 mg and 50 mg + 100 mg vial use, equals to 90% and 10%, respectively € 1930 0.11 0.07 € 17,954 € 28,431
 Palivizumab cost: Proportion of 100 mg and 50 mg + 100 mg vial use, equals to 40% and 60%, respectively € 2821 0.11 0.07 € 26,249 € 41,566
 Length of stay associated with RSV-H based on the pivotal trial (12.4 days pediatric ward, 38.1% ICU admission, 15.2 days ICU) [16] € 1118 0.11 0.07 € 10,402 € 16,471
 Indirect costs associated with prophylaxis, hospitalization, and respiratory sequelae excluded € 1223 0.11 0.07 € 11,374 € 18,010
 Costs associated with nosocomial infections excluded € 1715 0.11 0.07 € 15,954 € 25,263
 Exclude delayed surgeries pathway from decision tree € 1855 0.11 0.07 € 17,261 € 27,332
 Increased HCU in RSV-H: 0 years € 2027 0.11 0.07 € 18,861 € 29,866
 Increased HCU in RSV-H: 4 years € 1860 0.21 0.17 € 8882 € 11,189
  1. Abbreviations: QALYs, quality-adjusted life years; LY, life years; ICER, incremental cost-effectiveness ratio; RSV, respiratory syncytial virus; RSV-H, RSV infection resulting in hospitalization; ICU, intensive care unit; HCU, health care resource use