Related Experiment Video
Updated: May 9, 2026
Sublingual Immunotherapy as an Alternative to Induce Protection Against Acute Respiratory Infections
Published on: August 30, 2014
Cost-Effectiveness of Nirsevimab and Maternal RSVpreF Immunization Strategies in Low-Risk Infants
Sean Tsung1,2, Yan Bo Zeng1,3, Kevan Shah4,5
1Department of Management Science and Engineering, Stanford University, Stanford, California.
Insights
The mixed nirsevimab and RSVpreF immunization strategy is societally cost-effective for infants. However, from a healthcare perspective, neither this mixed strategy nor nirsevimab alone proved cost-effective compared to no immunization.
Area of Science:
- Pediatric infectious disease
- Health economics
- Public health policy
Background:
- The Advisory Committee on Immunization Practices (ACIP) recommended nirsevimab for infants and RSVpreF vaccine for pregnant individuals in 2023.
- These recommendations aim to prevent respiratory syncytial virus (RSV)-associated lower respiratory tract infections in infants.
- Cost-effectiveness of these strategies for healthy, low-risk infants requires evaluation.
Purpose of the Study:
- To compare the cost-effectiveness of the ACIP-recommended mixed nirsevimab and RSVpreF immunization strategy versus a nirsevimab-only strategy for healthy, low-risk infants in the United States.
- To analyze outcomes from both a healthcare sector and a societal perspective.
Main Methods:
- A decision tree with nested Markov models was used to compare three immunization strategies: no immunization, the mixed strategy, and nirsevimab-only.
- Health and societal outcomes were estimated using quality-adjusted life years (QALYs).
- Costs were assessed from both healthcare and societal perspectives, including caregiver productivity loss. Cost-effectiveness was determined using incremental cost-effectiveness ratios (ICERs) against a $150,000/QALY willingness-to-pay threshold.
Main Results:
- From the healthcare perspective, neither the mixed nor the nirsevimab-only strategy was cost-effective compared to no immunization.
- From the societal perspective, the mixed strategy was cost-effective ($117,848/QALY) compared to no immunization.
- Nirsevimab alone was not cost-effective compared to the mixed strategy due to higher product costs, but would be cost-effective if RSVpreF was unavailable ($134,391/QALY).
- Sensitivity analyses indicated results were sensitive to product costs and efficacy assumptions.
Conclusions:
- The ACIP-recommended mixed RSVpreF and nirsevimab strategy is a societally cost-effective method for infant protection against RSV.
- Pediatricians and obstetricians should collaborate to recommend these RSV immunizations.
- Further evaluation considering product costs and efficacy is warranted.
Objective:
In 2023, the Advisory Committee on Immunization Practices (ACIP) recommended both nirsevimab for infants aged less than 8 months and RSVpreF vaccine for pregnant patients at 32 to 36 weeks' gestation to prevent respiratory syncytial virus (RSV)-associated lower respiratory tract infections in infants. We compared the cost-effectiveness of the ACIP-recommended mixed nirsevimab and RSVpreF strategy vs a nirsevimab-only strategy for healthy, low-risk infants in the United States.
Methods:
A decision tree with nested Markov models compared 3 immunization strategies for healthy low-risk infants: no immunization, a mixed strategy of RSVpreF and nirsevimab per ACIP guidelines, and nirsevimab only for all infants. We estimated health and societal outcomes using quality-adjusted life years (QALYs) and costs from a health care sector perspective (ie, direct medical costs) and a societal perspective (ie, factors like caregiver productivity loss). We assessed cost-effectiveness using incremental cost-effectiveness ratios (ICERs) and a willingness-to-pay threshold of $150 000/QALY to benchmark cost-effectiveness and conducted sensitivity analyses.
Results:
From the health care sector perspective, neither the mixed strategy nor the nirsevimab-only strategy was cost-effective compared with no immunization, according to the $150 000/QALY threshold. From the societal perspective, the mixed strategy was cost-effective compared with no immunization ($117 848/QALY). Due to higher product costs, nirsevimab alone was not cost-effective compared with the mixed strategy ($347 821/QALY). However, if RSVpreF was not an option, the nirsevimab-only strategy would be cost-effective compared with no immunization ($134 391/QALY). Results were sensitive to assumptions about product costs and efficacy.
Conclusion:
Pediatricians and obstetricians should jointly recommend RSV immunizations, as the ACIP-recommended mixed RSVpreF and nirsevimab strategy is a societally cost-effective method to protect infants.
Related Concept Videos
01:03Rous Sarcoma Virus (RSV) and Cancer
RSV is a retrovirus that contains two copies of a plus-strand RNA genome. Its genome consists of four main open...
01:03Rous Sarcoma Virus (RSV) and Cancer
RSV is a retrovirus that contains two copies of a plus-strand RNA genome. Its genome consists of four main open...
01:19Rh Blood Group