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The impact of nirsevimab prophylaxis on RSV hospitalizations: a real-world cost-benefit analysis in Tuscany, Italy

Vieri Lastrucci¹, Martina Pacifici², Giorgia Alderotti¹

¹Epidemiology Unit, Meyer Children's Hospital IRCCS, Florence, Italy.

Frontiers in Public Health

|July 18, 2025

Insights

Nirsevimab prophylaxis for infants significantly reduces Respiratory Syncytial Virus (RSV) hospitalizations. A universal strategy offers broad protection, while targeted approaches show higher cost-benefit ratios, balancing economic impact with public health benefits.

Area of Science:

Pediatrics
Infectious Diseases
Health Economics

Background:

Respiratory Syncytial Virus (RSV) is a primary cause of infant hospitalizations.
Nirsevimab, a long-acting monoclonal antibody, offers extended RSV prophylaxis for all infants.
This study evaluates the cost-benefit of nirsevimab prophylaxis strategies in Tuscany, Italy.

Purpose of the Study:

To assess the cost-benefit of different nirsevimab prophylaxis strategies for infants during their first RSV season.
To compare these strategies against existing prophylaxis practices, including palivizumab.
To determine the impact on RSV-associated hospitalizations and healthcare costs.

Main Methods:

Analysis from a healthcare payor perspective using real-world data from the Tuscany birth cohort (N=21,017).
Evaluation of three nirsevimab prophylaxis strategies versus current practices for the 2023/2024 RSV season.
Calculation of net benefit and benefit-cost ratio (BCR), considering RSV-associated and severe hospitalizations.

Main Results:

Current practices led to 663 RSV hospitalizations (€5,247,645).
Universal nirsevimab prophylaxis avoided 378 hospitalizations with a BCR of 0.96.
A targeted seasonal strategy with catch-up for preterm infants yielded the highest BCR (1.56), preventing 270 hospitalizations.

Conclusions:

Universal nirsevimab prophylaxis substantially reduces infant hospitalization burdens without significant economic strain.
While targeted strategies are more cost-effective, universal prophylaxis maximizes public health impact by preventing more hospitalizations.

Read full analysis

Abstract

Background:

Respiratory Syncytial Virus (RSV) is the leading cause of hospitalizations in infants. The approval of nirsevimab, a long-acting monoclonal antibody, has extended the potential for RSV prophylaxis to all infants. This study assesses the cost-benefit of various Nirsevimab prophylaxis strategies for infants during their first RSV season in preventing RSV-associated hospitalization in the Tuscany region, Italy.

Methods:

The analysis was conducted from the perspective of the healthcare payor. Real-world data from the Tuscany birth cohort (N = 21,017) experiencing their first RSV season in the 2023/2024 season were used to calculate the net benefit and benefit cost ratio (BCR) of three possible nirsevimab prophylaxis strategies compared with prophylaxis practices at the time of the study, which includes the use of palivizumab in eligible infants. RSV-associated hospitalizations and severe hospitalizations were considered as health outcomes. Sensitivity analyses were performed to identify influential variables.

Results:

Under prophylaxis practices at the time of the study, there were a total of 663 hospitalizations associated with RSV, including 102 severe cases, representing €5,247,645 in costs. An extended prophylaxis strategy with nirsevimab, including all infants born both before and during the RSV season, resulted in the highest number of hospitalizations avoided (378), with a BCR close to break-even (0.96). A seasonal-only strategy targeting infants born during the season prevented the fewest hospitalizations (252), showing a positive BCR of 1.15. Finally, a seasonal strategy with targeted catch-up, including also preterm infants born before the season, yielded the highest cost-benefit ratio (1.56), preventing 270 hospitalizations.

Conclusion:

Universal prophylaxis strategies with nirsevimab, targeting all infants during their first RSV epidemic season, substantially reduce hospitalization burdens without increasing economic pressure on the healthcare system. Although alternative strategies are more cost-effective, they prevent fewer hospitalizations, emphasizing the public health value of broader prophylaxis approaches.

Keywords:

cost–benefit analysis hospitalizations immunization nirsevimab prevention respiratory syncytial virus (RSV)

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