Palivizumab for Infection Prevention in Inuit Infants: A Review of the Clinical Effectiveness and Cost-Effectiveness
Book. 2019 12 17
Authors: la Fleur P, Argáez C
Respiratory syncytial virus (RSV) can cause respiratory illness in persons of all ages and it is the leading cause of lower respiratory tract illness in children.1,2 The virus infects almost all children prior to 2 years of age during annual epidemics which, in Northern Hemisphere locations, occur seasonally between October to May. It can cause bronchiolitis and pneumonia and is estimated to be responsible for 3.4 million hospital admissions and approximately 200,000 deaths internationally in young children.3 Data suggest that the rates of hospitalization of children with RSV related illness in northern and Arctic communities in Canada are amongst the highest rates globally.4-6 Inuit children living in circumpolar regions have higher hospital admission rates for respiratory illness compared to those living in more southern areas.7 Several patient characteristics have been identified that carry a higher risk of morbidity and mortality including premature birth, infants with chronic lung disease, hemodynamically significant congenital heart disease, immunocompromised conditions and severe neuromuscular disease.8 Palivizumab is a monoclonal antibody against RSV and was approved for use in Canada in 2002. Palivizumab is indicated for the prevention of serious lower respiratory tract disease caused by RSV in pediatric patients at high risk of RSV disease. Some Canadian Arctic and far northern jurisdictions have provided government funding for palivizumab as prophylaxis since 2005.9 Coverage criteria vary across health jurisdictions and have included such restrictions as premature birth up to 35 weeks gestation or significant cardiac or respiratory conditions.10 For example, eligible children in Quebec can receive up to 5 monthly doses of palivizumab during the RSV season. The Quebec criteria for palivizumab prophylaxis includes children who are at greatest risk for developing serious respiratory illness due to RSV such as premature infants (<33 weeks of gestation) and children with a chronic respiratory disease or a congenital heart disease.7 In 2016, criteria in Quebec were modified to include healthy Nunavik children born at term and younger than 3 months of age at the start of the RSV season or born during the RSV season. Many Inuit infants who live in Northern regions do not have access to hospitals equipped to manage severe RSV illness and air evacuation to tertiary hospitals may be necessary. The appropriate use of palivizumab in Canadian northern and arctic communities has been the subject of debate in the scientific literature and the Canadian media.1,5,6,9-14 The purpose of this report is to determine the clinical effectiveness and cost effectiveness of universal versus high-risk palivizumab prophylaxis, and seasonal versus year-round palivizumab in Inuit children up to 4 years of age.