Implications for service provision

Prophylaxis with palivizumab does not represent good value based on the current UK ICER threshold of £30,000/QALY when used unselectively in pre-term infants and children without CLD/CHD or children with CLD or CHD. This subgroup analysis does show that prophylaxis with palivizumab may be cost-effective for some subgroups, which have been identified in this report. In summary, the cost-effective subgroups for children who had no CLD/CHD have to contain at least two of the other risk factors examined here apart from GA and AGE. The cost-effective subgroups for children who had CLD/CHD do not necessarily have any other of the modelled risk factors apart from GA and AGE.

Suggested research priorities

Future research should be directed towards the following:

• to conduct much larger, better powered and better reported studies to derive better estimates of risk factor effect sizes
• to update the effect sizes of the risk factors used in the current model, especially age, GA, MB and PE as the values of these parameters were derived from only one study
• to systematically identify the effect size of other risk factors, such as lack of or minimal breastfeeding and family history of atopy and enter them into the model to estimate the effect of additional risk factors on the cost-effectiveness
• to derive credible intervals for the 16,128 point estimates of cost-effectiveness of prophylaxis with palivizumab compared with no prophylaxis.