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An Improved and High Throughput Respiratory Syncytial Virus RSV Micro-neutralization Assay
Published on: January 26, 2019
Optimizing Timing for Respiratory Syncytial Virus Prevention Interventions for Infants
Danielle Nguyen1, Haeseon Lee1, Andrew T Pavia2
1Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City.
Insights
Maternal vaccine (MV) and nirsevimab are recommended for infant respiratory syncytial virus (RSV) protection. MV is cost-effective for RSV prevention in infants born early in the season, while nirsevimab is cost-effective only for the earliest months.
Area of Science:
- Public Health
- Health Economics
- Pediatrics
Background:
- The Centers for Disease Control and Prevention recommend maternal vaccine (MV) or nirsevimab for infant protection against respiratory syncytial virus (RSV).
- The cost-effectiveness of these interventions may vary based on administration timing, uptake, and efficacy.
Purpose of the Study:
- To evaluate the clinical outcomes and cost-effectiveness of maternal vaccine (MV) and nirsevimab for infant RSV prevention.
- To compare these interventions against no intervention for monthly birth cohorts and the entire RSV season.
Main Methods:
- Economic evaluation using a Markov model from a societal perspective.
- Analysis incorporated a willingness-to-pay threshold of $150,000 per QALY.
- Included infants born in the US during the RSV season (October-February).
Main Results:
- Maternal vaccine (MV) was cost-saving for infants born in October, November, and December, and cost-effective for the combined October-February cohort ($19,562/QALY).
- Nirsevimab was cost-effective compared to MV only for infants born in October ($67,178/QALY) and November ($88,531/QALY).
- MV was projected to avert 7,154 hospitalizations and 12 deaths; nirsevimab was projected to avert 11,893 hospitalizations and 19 deaths during the RSV season.
Conclusions:
- Administering maternal vaccine (MV) during the first four months and throughout the RSV season can be cost-effective.
- Nirsevimab demonstrated cost-effectiveness compared to MV only for infants born in October and November.
- Optimizing intervention use by restricting administration to specific months may be beneficial; further research on transmission dynamics is needed.
Importance:
The Advisory Committee on Immunization Practices and the Centers for Disease Control and Prevention recommend seasonal administration of maternal vaccine (MV) or nirsevimab to protect infants in the first year of life from respiratory syncytial virus (RSV) infections. Differences in uptake, costs, and efficacy between these agents may affect cost-effectiveness depending on the timing of administration.
Objective:
To evaluate the clinical outcomes and cost-effectiveness of no intervention, MV, and nirsevimab administration during the entire RSV season and separately for each monthly birth cohort from October through February.
Design, Setting, And Participants:
This economic evaluation used a Markov model to analyze cost-effectiveness from a societal perspective, applying a willingness-to-pay threshold of $150 000 per quality-adjusted life-year (QALY). Participants included infants born in the US during the RSV season. Data were accrued from October 2023 to June 2024 and analyzed from July 2024 to May 2025.
Interventions:
MV, nirsevimab administration, or no intervention.
Main Outcomes And Measures:
The primary outcome was the incremental cost-effectiveness ratio (cost per QALY gained). Clinical outcomes included the number of hospitalizations, outpatient infections, and deaths averted. Probabilistic sensitivity analyses were conducted.
Results:
An estimated monthly birth cohort of 299 277 infants was included in the analysis. Compared with no intervention, MV was cost-saving for infants in the October, November, and December cohorts and cost-effective in the January but not the February cohorts ($504 517/QALY). For infants born in the combined cohort (October-February), MV was cost-effective at $19 562/QALY. Compared with MV, nirsevimab was cost-effective only in October ($67 178/QALY) and November ($88 531/QALY). During the RSV season, MV was projected to avert 45 558 outpatient visits, 7154 hospitalizations, and 12 deaths; nirsevimab was projected to avert 92 265 outpatient visits, 11 893 hospitalizations, and 19 deaths. The probability of no intervention being cost-effective during the RSV season was 19.8%; MV, 62.2%; and nirsevimab, 18.0%.
Conclusions And Relevance:
In this economic evaluation of RSV prevention interventions, administration of MV in the first 4 months of and throughout the viral season could be cost-effective. Across the entire RSV season, nirsevimab was cost-effective compared with MV only in October and November. Intervention use may be optimized by restricting administration to select months. Further study is needed to assess transmission dynamics to refine cost-effectiveness outcomes.
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