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Published on: January 26, 2019
Optimal Respiratory Syncytial Virus intervention programmes using Nirsevimab in England and Wales
David Hodgson1, Mihaly Koltai1, Fabienne Krauer1
1Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.
Insights
Nirsevimab offers a cost-effective strategy for protecting infants against Respiratory Syncytial Virus (RSV) in England and Wales. Seasonal or extended seasonal programs demonstrate potential to replace current interventions, with optimal pricing varying by strategy.
Area of Science:
- Public Health
- Health Economics
- Infectious Disease Prevention
Background:
- Respiratory Syncytial Virus (RSV) is a leading cause of infant acute lower respiratory tract infections (ALRI).
- Current protective measures for infants include limited monoclonal antibody options.
- Nirsevimab, a novel monoclonal antibody, shows promise for extended infant protection against RSV.
Purpose of the Study:
- To evaluate the cost-effectiveness of Nirsevimab intervention programs in England and Wales.
- To determine optimal Nirsevimab administration strategies and pricing for infant protection.
- To compare Nirsevimab cost-effectiveness against existing Palivizumab programs.
Main Methods:
- A dynamic transmission model for RSV was developed and calibrated using data from England and Wales.
- Various Nirsevimab administration scenarios were analyzed: year-round, seasonal, and seasonal with catch-up.
- Cost-effectiveness was assessed using an Incremental Cost-Effectiveness Ratio (ICER) threshold of £20,000/QALY.
Main Results:
- A seasonal Nirsevimab program for all infants at birth requires a price of £63/dose or less to be cost-effective compared to Palivizumab.
- An extended seasonal program with catch-up is optimal at £32/dose or less.
- Seasonal program implementation costs could reach £2 million annually before a year-round strategy becomes more optimal.
Conclusions:
- Nirsevimab demonstrates potential for cost-effective use in England and Wales for infant RSV prevention.
- Intervention strategies, particularly seasonal and extended seasonal programs, offer viable alternatives to current methods.
- Nirsevimab's cost-effectiveness extends beyond high-risk infants, suggesting broader application potential.
Introduction:
Respiratory Syncytial Virus (RSV) is a major cause of acute lower respiratory tract infections (ALRI) in infants. There are no licensed vaccines and only one monoclonal antibody available to protect infants from disease. A new and potentially longer-lasting monoclonal antibody, Nirsevimab, showed promising results in phase IIb/III trials. We evaluate the cost-effectiveness of Nirsevimab intervention programmes in England and Wales.
Methods:
We used a dynamic model for RSV transmission, calibrated to data from England and Wales. We considered a suite of potential Nirsevimab programmes, including administration to all neonates (year-round); only neonates born during the RSV season (seasonal); or neonates born during the RSV season plus infants less than six months old before the start of the RSV season (seasonal + catch-up).
Results:
If administered seasonally to all infants at birth, we found that Nirsevimab would have to be priced at £63 or less per dose for at least 50% certainty that it could cost-effectively replace the current Palivizumab programme, using an ICER threshold of £20,000/QALY. An extended seasonal programme which includes a pre-season catch-up becomes the optimal strategy at a purchasing price of £32/dose or less for at least 50% certainty. At a purchasing price per dose of £5-32, the annual implementation costs of a seasonal programme could be as high as £2 million before a switch to a year-round strategy would be optimal.
Discussion:
Nirsevimab has the potential to be cost-effective in England and Wales not only for use in high-risk infants.
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