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ABSTRACT: Canadian, Inuit, full term infants have the highest rate of respiratory syncytial virus (RSV) infection globally, which results in substantial costs associated hospitalisation.
Decision-analytical techniques were used to estimate the incremental cost-effectiveness ratio (ICER) for palivizumab compared to no prophylaxis for Inuit infants of all gestational age. The time horizon was that of life-time follow-up, and costs and effectiveness were discounted at 5% per year. Costs (2007 CAD$) for palivizumab, hospitalisation (including medical evacuation, intensive care unit [ICU]), physician visits, and transportation were calculated based on the Canadian payer's perspective. Benefits on decreasing RSV hospitalisation were expressed as quality-adjusted life-years (QALYs). One-way and probabilistic sensitivity analysis (PSA) were conducted, varying: mortality rates, utilities, length of stay in hospital and ICU.
For all of Baffin Island infants (<1 year), the ICER was $39,435/QALY. However, when infants were grouped by age and area of residence, those residing in Iqaluit (<1 year) had an ICER of $152,145/QALY, while those residing in rural areas (outside of Iqaluit) had an ICER of $24,750/QALY. Prophylaxis was a dominant strategy (cost saving) for rural infants under 6 months of age, with the PSA demonstrating that it was dominant 98% of the time.
The ICERs suggested that palivizumab is a cost-effective option for the prevention of RSV for Inuit infants on Baffin Island compared to no prophylaxis. Palivizumab is highly cost effective in Arctic infants <1 year of age specifically residing outside of Iqaluit and is a dominant strategy for those under 6 months of age in rural areas. However, palivizumab is not cost effective compared to no treatment for infants of all ages residing in Iqaluit.
Journal of Medical Economics 11/2009; 12(4):361-70.
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Anna Banerji,
David Greenberg,
Laura Forsberg White,
W Alexander Macdonald,
Audrey Saxton,
Eva Thomas,
Douglas Sage,
Muhammad Mamdani,
Krista L Lanctôt,
James B Mahony,
Mia Dingle,
Ann Roberts
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ABSTRACT: To examine risk factors for lower respiratory tract infections (LRTI) hospital admission in the Canadian Arctic.
This was a case-control study during a 14-month period among children less than 2 years of age. Cases were admitted to the Baffin Regional Hospital in Iqaluit, Nunavut with LRTI. Controls were age matched and came from Iqaluit and 2 communities. Odds ratios (ORs) of hospital admission for LRTI were estimated through multivariate conditional logistic regression modeling for following risk factors: smoking in pregnancy, Inuit race, prematurity, adoption status, breast-feeding, overcrowding, and residing outside of Iqaluit. Viruses in nasophayngeal aspirates were sought at the time of each hospital admission.
There were 101 age-matched cases and controls. The following risk factors were significantly associated with an increased risk of admission for LRTI (adjusted OR): smoking in pregnancy (OR = 4.0; 95% CI: 1.1-14.6), residence outside of Iqaluit (OR = 2.7; 95% CI: 1.0 -7.2), full Inuit race (OR = 3.8; 95% CI: 1.1-12.8), and overcrowding (OR = 2.5, 95% CI: 1.1- 6.1). Non-breast-fed children had a 3.6-fold risk of being admitted for LRTI (95% CI: 1.2-11.5) and non-breast-fed adopted children had a 4.4-fold increased risk (95% CI: 1.1-17.6) when compared with breast-fed, nonadopted children. Prematurity was not associated with an increased risk of admission. Viruses were identified in 88 (72.7%) of admissions, with respiratory syncytial virus being identified in the majority of admissions, 62 (51.2%). Multiple viruses were isolated in 19 (15.7%) admissions.
Smoking during pregnancy, place of residence, Inuit race, lack of breast-feeding, and overcrowding were all independently associated with increased risk of hospital admission for LRTI among Inuit children less than 2 years of age. Future research on the role of adoption and genetics on the health of Inuit children are required.
The Pediatric Infectious Disease Journal 06/2009; 28(8):697-701. · 3.58 Impact Factor
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ABSTRACT: The objectives were to compare actual respiratory syncytial virus (RSV) hospitalization rates and costs in a cohort of Inuit infants to hypothetical palivizumab prophylaxis strategies for infants of all gestational ages in the Eastern Canadian Arctic.
Incidence and costs of RSV hospitalization were collected for infants admitted to the Baffin Regional Hospital in 2002, before the initiation of palivizumab. There was a comparison of the actual costs to the costs associated with 8 palivizumab strategies stratified by age (<6 months, <1 year) and location (overall, town [Iqaluit], rural communities). It was assumed that each category would receive universal palivizumab prophylaxis resulting in a 78% decrease in RSV admissions. The net costs incurred, number needed to treat (NNT), and incremental costs per hospitalization avoided were calculated for each comparison.
There was a great variation in the rates and costs associated with RSV admissions between Iqaluit and the communities. For infants <1 year of age residing in Iqaluit, the mean admission cost was $3915, and palivizumab prophylaxis had an NNT of 20.4 and cost of $162,551 per admission avoided. For rural infants <6 months, the mean cost of admission was $23,030, and palivizumab prophylaxis resulted in an NNT of 3.9 to 2.5 and cost savings of up to $8118 per admission avoided.
Due to the high rates and costs associated with RSV admissions, administration of palivizumab in rural communities in the Canadian Arctic to infants less than 6 months of age could result in net cost savings.
The Pediatric Infectious Disease Journal 05/2009; 28(8):702-6. · 3.58 Impact Factor
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Canadian Medical Association Journal 07/2005; 172(13):1678-9. · 8.22 Impact Factor
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ABSTRACT: To determine the prevalence of Simkania negevensis in causing pulmonary infections in children, nasopharyngeal washes were obtained from 22 infants hospitalized with acute bronchiolitis in the Baffin Island, Canada. 14 (63.6%) were positive for S. negevensis. Mixed infections with other respiratory viruses were common. All patients recovered without specific antibiotic treatment. Even though a high prevalence of S. negevensis was found, this organism may potentially well be an opportunistic agent rather than a true pathogen.
Scandinavian Journal of Infectious Diseases 02/2003; 35(8):506-8. · 1.72 Impact Factor
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ABSTRACT: Few studies have examined the epidemiology of imported malaria in Canadian children. Identifying populations at increased risk in Canada would enable targeted malaria prevention strategies within those groups. The study objective was to describe the epidemiology of malaria diagnosed at British Columbia's Children's Hospital (BCCH) between 1984 and 2001.
This was a retrospective chart review of malaria cases identified at BCCH and confirmed through the British Columbia Centre for Disease Control. Demographic and clinical data were recorded on a standardized form.
Malaria was diagnosed 42 times in 40 children (age 24 days to 14.8 years). Thirty cases (71.4%) occurred in 28 Canadian residents, and 12 (28.6%) occurred in immigrant or refugee children. Twenty-six children (65%) were male. Thirty-one children (77.5%) were of East Indian descent. Thirty-three exposures (78.6%) to malaria occurred in the Indian subcontinent. Plasmodium vivax was identified in 37 cases (88.1%), P. falciparum in 3 (7.1%), and the species was unknown in 2 (4.8%). Fourteen cases in the resident children (46.7%) reported pre-travel counselling. Ten resident cases (33.3%) were prescribed chemoprophylaxis, primarily chloroquine, and at least six of them (60%) were non-compliant. The duration of symptoms prior to diagnosis was < 7 days in 27 cases (64.3%), 8 to 30 days in 10 (23.8%), > 30 days in 4 (9.5%) and the duration was unknown in 1 (2.5%). Twenty-four of 36 cases (66.7%) had seen 2 to more than 4 doctors before the diagnosis of malaria was made.
The majority of children in our review were of East Indian origin and were exposed to malaria in India. Most had not sought or had received inadequate pre-travel counselling and had been non-compliant with chemoprophylaxis. As malaria is a potentially lethal but preventable disease, strategies to ensure adequate pre-travel counselling for high-risk groups are required.
Canadian journal of public health. Revue canadienne de santé publique 95(4):245-8. · 1.02 Impact Factor
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ABSTRACT: Respiratory syncytial virus (RSV) is a common infection in infancy, with nearly all children affected by two years of age. Approximately 0.5% to 2.0% of all children are hospitalized with lower respiratory tract disease, of which 50% to 90% have bronchiolitis and 5% to 40% have pneumonia. Morbidity and mortality are highest in children with nosocomial infection and in those with underlying medical illnesses such as cardiac and chronic lung disease. Aboriginal children residing in remote northern regions are specifically considered to be at high risk for hospitalization due to RSV infection. Thorough hand washing and health education are the principal strategies in primary prevention. In the absence of a vaccine, palivizumab prophylaxis is currently the best intervention to reduce the burden of illness and RSV-related hospitalization in high-risk children. Health care professionals should provide palivizumab prophylaxis cost effectively in accordance with recommendations issued by pediatric societies and national advisory bodies. The present article reviews the epidemiology of RSV infection and the short- and long-term impact of disease in high-risk infants and special populations. Prevention strategies and treatment are discussed based on the existing scientific evidence, and future challenges in the management of RSV infection are addressed.
Canadian respiratory journal: journal of the Canadian Thoracic Society 18(2):e10-9. · 1.56 Impact Factor
