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Table 4 Values and sources of model’s parameters

From: Should we use Palivizumab immunoprophylaxis for infants against respiratory syncytial virus? – a cost-utility analysis

   Value   Source(s)
Epidemiologic
 Infants with BPD   0.037%   [55]
 Infants with CHD   0.028%   [55]
 Infants with CLD   0.084%   [55]
  < 29 weeks gestation   0.42%   [56]
 29–32 weeks gestation   0.88%   [56]
 33–36 weeks gestation   6.13%   [56]
 No Risk group   92.42%   [56]
  0–5 6–11 12–23  
  months months months  
Life Expectancy (years) 82.1 81.6 81.1 [4]
HALE (Health Adjusted Life Expectancy) 71.9 71.5 70.8 [a]
Discounted HALE 29.13 29.07 28.96 [a]
RSV Mortality per 1000 cases
  BPD 0.322 0.117 0.032 [6, 57,58,59]
  CHD 0.658 0.330 0.045 [6, 57,58,59]
  CLD 0.303 0.136 0.034 [6, 57,58,59]
  <29 0.204 0.096 0.010 [6, 57,58,59]
  29–32 0.186 0.018 0.004 [6, 57,58,59]
  33–36 0.073 0.030 0.009 [6, 57,58,59]
  No risk 0.013 0.004 0.001 [6, 57,58,59]
Immunoprophylaxis Efficacy against RSV Mortality
  BPD   0.17   [21]
  CHD   0.22   [21]
  CLD   0.17   [21]
  < 29   0.73   [21]
  29–32   0.76   [21]
 33–36   0.79   [21]
 No risk   0.81   [21]
Utilization
Hospitalizations in persons < 2 years old
  (AB: Acute Broncholiosis)
  AB with RSV (466.11)   2011   [b]
  % unknown diagnoses that are RSV   40%   [11]
  AB unknown organisms: RSV (466.99)   843   [b]
  RSV Pnuemonia (210.1)   50   [b]
  % Otitis Media caused by RSV   15%   [8,9,10]
  Otitis Media RSV   196   [b, c]
  RSV < 2 yrs. old   3100   [b]
  RSV 12–23 months   381   [b]
  RSV 6–11 months   662   [b]
  RSV < 6 months old   2057   [b]
  Average length of stay aged 12–23 months   3.7 days [b]
  Average length of stay aged 6–11 months   3.6 days [b]
  Average length of stay < 6 months old   4.2 days [b]
Relative Risks of Hospitalizations in Unvaccinated Children
  0–5 6–11 12–23  
  months months months  
BPD 8.6 9.6 9.0 [58, 60]
CHD 2.7 4.2 2.0 [58, 60]
CLD 3.9 5.4 4.6 [58, 60]
<29 5.3 7.6 2.8 [58, 60]
29–32 3.4 6.2 5.4 [58, 60]
33–36 1.9 2.4 2.4 [58, 60]
No risk 1.0 1.0 1.0  
Average Lengths of Stay: General Wards (days) - Unvaccinated Children
  0–5 6–11 12–23  
  months months months  
BPD 8.0 6.7 7.0 [6, 29, 61]
CHD 7.7 6.4 6.8 (b, [62])
CLD 7.9 6.6 6.9 (b, [62])
<29 3.7 3.0 3.2 (b, [62])
29–32 4.5 3.7 3.9 (b, [62])
33–36 5.8 4.8 5.0 (b, [62])
No risk 3.9 3.3 3.5 (b, [62])
Average Lengths of Stay ICU (days) - Unvaccinated Persons
  0–23    
  months    
BPD 9.1    [59, 62]
CHD 10.1    [59, 62]
CLD 16.1    [59, 62]
<29 11.8    [59, 62]
29–32 12.3    [59, 62]
33–36 12.8    [59, 62]
No risk 6.7    [b]
Average Lengths of Stay General Wards (days) - Vaccinated Children
  0–5 6–11 12–23  
  months months months  
BPD 7.0 5.8 6.1 (b,[6])
CHD 5.3 4.4 4.7 (b,[41, 61])
CLD 5.4 4.5 4.8 (b,[41, 61])
<29 2.8 2.3 2.4 (b, [63])
29–32 3.4 2.8 3.0 (b, [63])
33–36 4.4 3.6 3.8 (b, adjusted [63])
No risk 3.0 2.5 2.6 (b, adjusted [63])
Average Lengths of Stay ICU (days) - Vaccinated Persons
  0–23    
  months    
BPD 3.9    (b,[6])
CHD 4.4    (b,[41, 61])
CLD 7.0    (b,[41, 61])
<29 5.9    (b, [63])
29–32 6.1    (b, [63])
33–36 6.4    (b, adjusted [63])
No risk 3.3    (b,adjusted [63])
Ratio of Ambulatory Visits to Hospitalizations
  0–5 6–11 12–23  
  months months months  
BPD 3.7 26.0 16.9 [64,65,66]
CHD 3.7 26.0 16.9 [64,65,66]
CLD 3.7 26.0 16.9 [64,65,66]
<29 3.7 26.0 16.9 [64,65,66,67]
29–32 3.7 26.0 16.9 [64,65,66,67]
33–36 3.8 26.5 17.3 [64,65,66,67]
No risk 3.9 26.7 17.4 [64,65,66,67]
Ratio of Emergency Room Visits to Hospitalizations
  0–5 6–11 12–23  
  months months months  
BPD 0.3 1.3 1.3 [64,65,66]
CHD 0.3 1.3 1.3 [64,65,66]
CLD 0.3 1.3 1.3 [64,65,66]
<29 0.3 1.3 1.3 [64,65,66,67]
29–32 0.4 1.4 1.4 [64,65,66,67]
33–36 0.5 1.9 1.9 [64,65,66,67]
No risk 0.5 2.0 2.0 [64,65,66,67]
RSV Sequelae
Relative Risks by age for Asthma after Hospitalization for RSV
  0–5 6–11 12–23  
  months months months  
BPD,CHD,CLD 1.03 1.05 1.17 assumed as for 29–32 weeks
<29 1.03 1.06 1.20 [68,69,70,71,72]
29–32 1.03 1.05 1.17 [68,69,70,71,72]
33–36 1.02 1.04 1.15 [68,69,70,71,72,73]
No risk 1.03 1.05 1.10 [68,69,70,71,72,73]
  3–10 11–20 21+  
  years years years  
BPD,CHD,CLD 1.11 1.09 1.14 assumed as for 29–32 weeks
<29 1.12 1.10 1.17  
29–32 1.11 1.09 1.14  
33–36 1.08 1.07 1.12  
No risk 1.09 1.09 1.15  
  [68, 71, 72, 74,75,76,77,78,79,80,81] [68, 72, 78, 80] [68, 72, 78, 80] [age-specific]
Asthma attacks per year in not-fully controlled   5.0   Assumption
Asthma cases fully controlled   50%   Assumption
Severe Wheezing episodes per year (aged 3+ years)   5 [13]  
Relative Risks by age for Physician Confirmed Wheezing after Hospitalization for RSV
  0–5 6–11 12–23  
  months months months  
BPD,CHD,CLD 1.25 1.25 1.25 assumed as for 29–32 weeks
<29 1.29 1.29 1.29 [68]
29–32 1.25 1.25 1.25 [68]
33–36 1.21 1.21 1.21 [68, 73]
No risk 1.24 1.24 1.13 [68, 70, 73]
  2–3 4–5 6–12  
  years years years  
BPD,CHD,CLD 1.14 1.03 1.00 assumed as for 29–32 weeks
<29 1.15 1.03 1.00  
29–32 1.14 1.03 1.00  
33–36 1.08 1.04 1.001  
No risk 1.07 1.06 1.04  
  [46, 68, 82,83,84] [68, 73] [68, 73] [age-specific]
Demographic
 Average Population (2015)   7,978,067   [2]
 Live Births (2015)   178,723   [2]
Disability weights
 Infants aged 0–11 months   0.00675   [a]
 Infants aged 12–23 months   0.00770   [a]
 Pre-Hospital Phase   0.17   [14]
 Pre-Hospital Phase (caregiver)   0.03   [14]
 Ambulatory Visit (included in pre-hospital)   0   
 ER visit (included in pre-hospital)   0   
 Days in Hospital   0.40   [14]
 Days in Hospital (caregiver)   0.04   [14]
 Post-Hospital Phase   0.09   [14]
 Post-Hospital Phase (caregiver)   0.01   [14]
 Out-patient visit (included in post-hospital)   0   
 % asthma controlled or partly controlled   50%   [84]
 Asthma (included after chronic phase)   0.018   [84]
 Wheezing (included after chronic phase)   0.0018 per episode [13]
 Chronic Phase   0.011   [14]
Duration of Disability
 Pre-Hospital Phase days 3.5   [57]
 Post-Hospital phase days 60   [14]
 Chronic Phase days 122   [14, 19]
 Asthmatic days per year 365   Assumed
Economic
 Exchange rate 2015 NIS per USD 3.89   [4]
 Discount Rate   3%   Standard practice.
 GDP per Capita 2015   $35,341   [4]
 Cost-effectiveness threshold   $105,986   [5]
Unit Costs
 Ambulatory Physician per visit $12.83   [85]
 Emergency Room per visit $209   [86]
 General Hospital Ward per day $526   [86]
 ICU to Pediatric Ward Cost Ratio   3.12   [17, 24, 41, 87]
 Out-Patient Department per visit $72   [85]
 Asthma - aged 0–5 per year $1147   [12]
 Asthma - aged 6–17 per year $1311   [12]
 Asthma - aged 18+ per year $3200   [12]
 Wheezing per year $1089   [13]
 Mortality per death $4690   Local Burial prices
Immunoprophylaxis Costs
 Immunoprophylaxis Cost-50 mg vial   $520   [d]
 Immunoprophylaxis Cost-100 mg vial   $957   [d]
 Immunoprophylaxis cost per dose for 0–5 months infant   $1054   (d,[16])
 Immunoprophylaxis cost per dose for 6–11 months infant   $1378   (d,[16])
 Immunoprophylaxis cost per dose for 12–23 months infant   $1628   (d,[16])
 Average cost per Immunoprophylaxis course   $6281   Derived from Model
 Immunoprophylaxis wastage   3.3%   [7]
 Hospital Doctors Costs per hour $41   [85]
 Nurses Empoyment Costs per hour $27   [85]
 Secretarial Costs per hour $15   [85]
 MD time per Immunoprophylaxis dose mins 6.1   [85]
 Nurses time per Immunoprophylaxis dose mins 30   [15, 17]
 Secretarial time per Immunoprophylaxis dose mins 3.0   Estimated
 Average No. of Immunoprophylaxis shots:BPD   4.87   [61]
 Average No. of Immunoprophylaxis shots: non-BPD   4.93   [6]
Caregiver Work Losses
 Average gross wage costs USD per hour 13.26   [4]
 Social overheads as % gross wage   25%   [e]
 Work hours per day hours 7.18   [4]
 Time off work per vaccination hours 4   Approximation
 Time off/attack in uncontrolled asthmatics hours 10.77   Assumed 1–2 days
 Time off per severe wheezing Episode hours 10.77   Assumed 1–2 days
  0–5 6–11 12–23  
  months months months  
% mothers working full time before pregnancy 45% 45% 45% [4]
% on maternity leave 67% 10% 0% [4]
% taking time of work for caring for sick child 15% 41% 45% [4]
Length of work absence (non-hospitalized) days 5.9 5.3 5.5 Assumed 50% of hospitalized cases
Length of work absence (hospitalized) days 11.8 10.7 11.0 [f]
Notes:     
a) Calculations by Gary Ginsberg on HALE [4, 88]     
b) Department of Information. Ministry of Health.     
c) ICD 9 codes 017.4, 053.2, 381.0–381.4, 382.0     
d) MOH prices excluding VAT     
e) Average employers contribution to pension, health care and national insurance.     
f) Pre-hospital plus twice Average Length Of Stay