Cost-effectiveness of introducing a maternal vaccine or long-acting monoclonal antibody to prevent infant respiratory syncytial virus disease in Nepal

Neele Rave ¹, Arun K Sharma ^2,3, Ram H Chapagain ^4,3

⁰Department of Paediatrics, University Medical Centre Utrecht, Utrecht, the Netherlands.

Journal of Global Health +

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November 13, 2025

View abstract on PubMed

Summary

Introducing new respiratory syncytial virus (RSV) vaccines in Nepal could prevent thousands of infant deaths and hospitalizations. The maternal vaccine appears more cost-effective, but pricing is key for policy decisions.

Area Of Science

Public Health
Vaccinology
Health Economics

Background

The World Health Organization recommends passive immunization for infants against respiratory syncytial virus (RSV).
Cost-effectiveness of maternal vaccines (RSVpreF) and infant monoclonal antibodies (mAbs) (nirsevimab) needs evaluation in low- and middle-income countries like Nepal.
Preliminary cost-effectiveness estimates are crucial for guiding Nepal's immunization policy for RSV prevention.

Purpose Of The Study

To estimate the health impact and cost-effectiveness of introducing a maternal RSV vaccine (RSVpreF) versus an infant monoclonal antibody (mAb) (nirsevimab) in Nepal from 2025-2034.
To compare these interventions against the status quo (no intervention) and against each other.
To inform immunization policy and planning in Nepal regarding RSV prevention strategies.

Main Methods

Cost-effectiveness analysis using a Markov model, comparing maternal vaccine and infant mAb to no intervention.
Incorporated health care costs from a Kathmandu cost-of-illness study and recent clinical trial efficacy data.
Primary outcome: incremental cost per disability-adjusted life year (DALY) averted from a governmental health perspective, with sensitivity and probabilistic uncertainty analyses.

Main Results

Both maternal vaccine and infant mAb could prevent over 2300 deaths and 50,000 hospitalizations in Nepal over ten years.
Estimated costs per DALY averted were USD 387 for the maternal vaccine and USD 486 for the infant mAb.
The maternal vaccine showed a 95% probability of cost-effectiveness at USD 5/dose, dominating the mAb in base-case assumptions; however, results are sensitive to price and efficacy.

Conclusions

New passive immunization strategies offer significant potential to reduce RSV burden in Nepal.
The choice between maternal vaccines and infant mAbs will heavily depend on negotiated product pricing.
Cost-effectiveness is strongly influenced by price, efficacy, duration of protection, and RSV disease burden estimates.

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