We welcome the opportunity to reply to Mahadevia and Malinoski's comments on our article, which correctly highlight the challenges of performing cost-effectiveness analyses (CEA) when complete data for components of the model are not available in the literature.
They state that our model1 undervalues the benefit of avoiding asthma following respiratory syncytial virus (RSV) infection. First, as noted in our article,1 a causal relationship between RSV infection and asthma has not been established. Second, factors that increase susceptibility to RSV infection likely also confer increased risk of asthma later. Incorporating future risk of asthma in a CEA model of RSV prophylaxis using palivizumab is novel and has not been included in prior CEA studies. Despite including future risk of asthma, which favors the cost-effectiveness of RSV prophylaxis, our analysis did not find palivizumab to be cost-effective. Third, few studies of the health status of children with asthma include instruments that yield appropriate data for inclusion in cost-effectiveness analyses; we used the best data available at that time of our analysis. In a more recent report, adult assessment of quality of life for children with at least mild or moderate asthma found an average quality of life of 0.83.2 This value is within the range included in our sensitivity analyses. Our sensitivity analyses showed that the value for quality of life with asthma must be no greater than 0.80 for RSV prophylaxis to be considered cost-effective for any of the groups in our analyses.
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