Clinical and economic evaluation of risk factor guided respiratory syncytial virus prophylaxis in Colombian preterm infants

This peer-reviewed article, evaluates the cost-effectiveness of risk factor–guided respiratory syncytial virus (RSV) prophylaxis among preterm infants in Colombia. The study develops a Colombian-adapted version of the International Risk Scoring Tool (IRST) and applies a cost-utility model to assess the use of palivizumab prophylaxis versus no intervention in infants born at 32–35 weeks’ gestational age. The analysis uses local epidemiological and cost data and models health and economic outcomes over a lifetime horizon from a healthcare provider perspective.

Key findings:

• A localized version of the IRST, incorporating gestational age, smoking exposure, siblings/daycare attendance, breastfeeding practices, and maternal education, showed strong predictive performance for RSV hospitalization risk (AUROC: 0.823).
• Among moderate- and high-risk infants identified using the tool, the RSV hospitalization rate was estimated at 18.6%.
• Palivizumab prophylaxis for these higher-risk infants was cost-effective compared to no intervention, with an incremental cost of approximately COP20.2 million (USD4,752) per QALY gained.
• The intervention had a 61.1% probability of being cost-effective at a willingness-to-pay threshold equivalent to Colombia’s GDP per capita.
• Including societal costs further improved cost-effectiveness, while assumptions such as no vial sharing or shorter duration of long-term morbidity increased costs but generally remained within or near cost-effectiveness thresholds.
• The adapted IRST enables better targeting of prophylaxis, improving efficiency by focusing on infants at greatest risk of severe RSV outcomes.

Thumbnail image credit: Wellington Tavares