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Maternal RSV vaccination to protect infants in Brazil: a model-based cost-effectiveness analysis for incorporation

Sophia Aguiar Monteiro Borges1,2, Erick Ohanesian Polli1, Ana Carolina Nonato1

  • 1Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.

Lancet Regional Health. Americas
|January 16, 2026
PubMed

Insights

Maternal immunization against respiratory syncytial virus (RSV) in Brazil could reduce disease burden but is not cost-effective at current prices. Significant vaccine price reduction is needed to meet Brazil's cost-effectiveness threshold.

Area of Science:

  • Public Health
  • Vaccinology
  • Health Economics

Background:

  • Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections in young children in Brazil.
  • Maternal immunization with the RSV prefusion F protein vaccine (RSVpreF) shows high efficacy in protecting infants against RSV-LRTI in their first six months.
  • Cost-effectiveness of maternal RSV immunization in Brazil requires evaluation.

Purpose of the Study:

  • To assess the cost-effectiveness of implementing a maternal RSV immunization program in Brazil.
  • To compare maternal vaccination versus no vaccination from healthcare system and societal perspectives.
  • To determine the conditions under which maternal RSV immunization would be cost-effective in Brazil.

Main Methods:

  • A decision tree model was used, following a birth cohort through their first year of life.
  • Data were sourced from Brazilian Health Information Systems, administrative databases, and international literature.
  • The primary outcome was the incremental cost-effectiveness ratio (ICER) per disability-adjusted life year (DALY) averted, using a threshold of $8000 USD per DALY.

Main Results:

  • At 50% coverage, maternal RSV vaccination could prevent ~37,000 RSV cases, 9400 hospitalizations, and avert 80 deaths and 1660 DALYs annually.
  • The ICERs were $29,700 (healthcare system) and $29,200 (societal), significantly exceeding Brazil's $8000 threshold.
  • Vaccine price and efficacy were the most influential parameters; a dose price around $12 USD would be needed for cost-effectiveness.

Conclusions:

  • Maternal RSV immunization could substantially reduce the disease burden in Brazil.
  • Current vaccine prices prevent the program from meeting Brazil's cost-effectiveness threshold.
  • Significant price reductions are necessary for widespread implementation of maternal RSV immunization in Brazil.
Abstract

Keywords:
Cost-effectiveness analysisMaternal immunizationRespiratory syncytial virusVaccine

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