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An Improved and High Throughput Respiratory Syncytial Virus RSV Micro-neutralization Assay
Published on: January 26, 2019
Effectiveness and cost-effectiveness of RSV infant and maternal immunization programs: A case study of Nunavik,
Shokoofeh Nourbakhsh1, Affan Shoukat1, Kevin Zhang2
1Agent-Based Modelling Laboratory, York University, Toronto, Ontario M3J 1P3, Canada.
Insights
New respiratory syncytial virus (RSV) immunizations, like long-acting monoclonal antibodies (LAMA) and maternal vaccines, offer significant cost savings and effectiveness. These advanced prophylactics reduce hospitalizations better than palivizumab, especially in severe seasons.
Area of Science:
- Public Health
- Immunization Programs
- Health Economics
Background:
- Respiratory syncytial virus (RSV) poses a substantial health and economic burden despite current passive immunization strategies like palivizumab.
- High-risk infants under two years are targeted, but effectiveness and cost-efficiency of newer prophylactics require evaluation.
Purpose of the Study:
- To evaluate the effectiveness and cost-effectiveness of novel RSV immunization programs in Nunavik, Canada.
- Assess new prophylactics, including long-acting monoclonal antibodies (LAMA) and maternal vaccines, for reducing RSV hospitalizations.
Main Methods:
- An agent-based model simulated RSV transmission in Nunavik, Quebec.
- Compared palivizumab, LAMA, and maternal vaccination strategies across different RSV season severities.
- Calculated incremental cost-effectiveness ratios (ICER) using quality-adjusted life-years (QALYs) gained.
Main Results:
- Palivizumab for healthy infants was not cost-effective; focusing on high-risk infants is more efficient.
- LAMA prophylaxis demonstrated moderate to high cost-effectiveness (CAD $39,414/QALY in mild, $5,255/QALY in moderate seasons).
- LAMA was cost-saving in severe seasons; maternal vaccination combined with infant immunization was cost-saving in all seasons.
Conclusions:
- Transitioning from palivizumab to LAMA and maternal vaccines can yield significant healthcare savings.
- New prophylactics like LAMA are effective in reducing RSV hospitalizations without compromising public health benefits.
Background:
Despite passive immunization with palivizumab to select high-risk children under two years of age, the health and economic burden of respiratory syncytial virus (RSV) remains substantial. We evaluated the effectiveness and cost-effectiveness of immunization programs with new generations of RSV prophylactics, including long-acting monoclonal antibodies (LAMA) and maternal vaccines, in terms of reducing hospitalizations in Nunavik, a Canadian Arctic region.
Methods:
We developed an agent-based model of RSV transmission and parameterized it with the demographics and burden of RSV in Nunavik, Québec. We compared various immunization strategies, taking into account the costs associated with program delivery and calculating the incremental cost-effectiveness ratio (ICER) using quality-adjusted life-years (QALYs) gained as a measure of effectiveness. Scenario analyses included immunization with palivizumab and LAMA for infants under one year of age, and maternal vaccination in mild, moderate, and severe RSV seasons. Data were analysed from November 1, 2019 to May 1, 2021.
Findings:
We found that a Nunavik pilot program with palivizumab which included healthy full-term infants aged 0-2 months in addition to those considered high-risk for complicated RSV disease is not cost-effective, compared to offering palivizumab only to preterm/chronically ill infants under 1 year of age. Using LAMA as prophylaxis produces ICER values of CAD $39,414/QALY (95% Credible Interval [CrI]: $39,314-$40,017) in a mild season (moderately cost-effective) and CAD $5,255/QALY (95% CrI: $5,222-$5,307) in a moderate season (highly cost-effective). LAMA was a dominant (cost-saving with negative incremental costs and positive incremental effects) strategy in a severe RSV season. Maternal vaccination combined with immunization of preterm/chronically ill infants 3-11 months was also a dominant (cost-saving) strategy in all seasons.
Interpretation:
The switch from palivizumab in RSV immunization programs to new prophylactics would lead to significant savings, with LAMA being an effective strategy without compromising benefits in terms of reducing hospitalizations.
