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An Improved and High Throughput Respiratory Syncytial Virus (RSV) Micro-neutralization Assay
Published on: January 26, 2019
Cost-effectiveness of potential infant vaccination against respiratory syncytial virus infection in The Netherlands
M J Meijboom1, M H Rozenbaum, A Benedictus
1Unit of PharmacoEpidemiology & PharmacoEconomics (PE(2)), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
Insights
Infant respiratory syncytial virus (RSV) vaccination may be cost-effective, potentially averting thousands of hospitalizations and deaths annually. Further clinical trial data are needed to confirm these findings for RSV prevention.
Area of Science:
- Pediatric infectious diseases
- Vaccine economics
- Public health modeling
Background:
- Respiratory syncytial virus (RSV) is a leading cause of respiratory illness in infants, affecting nearly all children by age two.
- Several RSV vaccine candidates are in early-stage clinical trials for infants, but efficacy data are not yet available.
- Cost-effectiveness analysis can inform the potential positioning of new RSV vaccines.
Purpose of the Study:
- To estimate the cost-effectiveness of infant vaccination strategies against RSV.
- To model the impact of different vaccination schedules on disease burden and healthcare costs.
- To provide preliminary economic insights for RSV vaccine development and implementation.
Main Methods:
- A decision analysis model simulating a Dutch birth cohort over 12 months.
- Evaluation of vaccination strategies including age, dosing schedules (2- or 3-dose), and timing (seasonal vs. year-round).
- Sensitivity analyses, including probabilistic analysis, were performed to assess the impact of assumptions on outcome measures like hospitalizations, deaths, costs, and quality-adjusted life years (QALYs).
Main Results:
- Without vaccination, RSV causes an estimated 28,738 GP visits, 1623 hospitalizations, and 4.5 deaths annually in infants, with societal costs of €7.7 million and a burden of 597 QALYs.
- A 3-dose infant vaccination scheme (at 0, 1, and 3 months) could avert 544 hospitalizations and 1.5 deaths annually, at an estimated incremental cost-effectiveness ratio (ICER) of €34,142 per QALY gained.
- Optimized schedules (reduced doses, seasonal vaccination) improved ICERs, while reduced vaccine efficacy or delayed vaccination worsened them.
Conclusions:
- Infant vaccination against RSV shows potential for cost-effectiveness based on current disease burden estimates.
- The model highlights the importance of vaccine characteristics, such as efficacy and timing, in determining economic outcomes.
- Clinical trial data are essential to validate these preliminary cost-effectiveness findings and guide RSV vaccine implementation.
Introduction:
Respiratory syncytial virus (RSV) infection is one of the major causes of respiratory illness in infants, infecting virtually every child before the age of 2 years. Currently, several Phase 1 trials with RSV vaccines in infants are ongoing or have been completed. As yet, no efficacy estimates are available for these vaccine candidates. Nevertheless, cost-effectiveness estimates might be informative to enable preliminary positioning of an RSV vaccine.
Methods:
A decision analysis model was developed in which a Dutch birth cohort was followed for 12 months. A number of potential vaccination strategies were reviewed such as vaccination at specific ages, a two- or three-dosing scheme and seasonal vaccination versus year-round vaccination. The impact of the assumptions made was explored in various sensitivity analyses, including probabilistic analysis. Outcome measures included the number of GP visits, hospitalizations and deaths, costs, quality-adjusted life years and incremental cost-effectiveness ratios (ICERs).
Results:
Currently, without vaccination, an annual number of 28,738 of RSV-related GP visits, 1623 hospitalizations, and 4.5 deaths are estimated in children in the age of 0-1 year. The total annual cost to society of RSV in the non-vaccination scenario is €7.7 million (95%CI: 1.7-16.7) and the annual disease burden is estimated at 597 QALYs (95%CI: 133-1319). In case all infants would be offered a potentially safe and effective 3-dose RSV vaccination scheme at the age of 0, 1 and 3 months, the total annual net costs were estimated to increase to €21.2 million, but 544 hospitalizations and 1.5 deaths would be averted. The ICER was estimated at €34,142 (95%CI: € 21,652-€ 87,766) per QALY gained. A reduced dose schedule, seasonal vaccination, and consideration of out-of-pocket expenses all resulted in more favorable ICER values, whereas a reduced vaccine efficacy or a delay in the timing of vaccination resulted in less favorable ICERs.
Discussion:
Our model used recently updated estimates on the burden of RSV disease in children and it included plausible utilities. However, due to the absence of clinical trial data, a number of crucial assumptions had to be made related to the characteristics of potential RSV vaccine. The outcomes of our modeling exercise show that vaccination of infants against RSV might be cost-effective. However, clinical trial data are warranted.
