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An Improved and High Throughput Respiratory Syncytial Virus RSV Micro-neutralization Assay
Published on: January 26, 2019
Estimating the cost-effectiveness of respiratory syncytial virus (RSV) vaccination program for older Australian
Kishor K Paul1, Monica Torres2, Sophy T F Shih3
1School of Population Health, University of New South Wales, Australia.
Introduction:
Vaccination is now available as a tool to reduce the burden of respiratory syncytial virus (RSV), a leading cause of healthcare use and mortality among infants and older adults around the world, including in Australia. With the recent approval of two adult RSV vaccines in Australia, it is timely to evaluate their potential costs and benefits.
Methods:
We applied a static multi-cohort Markov model to estimate the cost-effectiveness of a single-dose vaccination program for Australians aged ≥75 years with Arexvy and Abrysvo. Data on RSV epidemiology, healthcare use and costs were used as model inputs, and a healthcare system perspective was applied. The primary outcome was the incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained compared to a no vaccination scenario.
Results:
The RSV vaccination program for Australians aged ≥75 years was estimated to be cost-effective at a vaccine price less than approximately A$165 for Arexvy and A$176 for Abrysvo, assuming a willingness-to-pay (WTP) threshold of A$50,000/QALY gained. To be cost-effective at a WTP of A$15,000/QALY gained, Arexvy and Abrysvo need to be priced below A$97 and A$104, respectively. Most of the estimated cost savings (80%-85%) were attributable to preventing RSV hospitalisations, and the majority of the QALY gains were attributed to avoided RSV deaths in vaccinated individuals. The ICER was most sensitive to hospitalisation probability, vaccine price, RSV incidence, and probability of symptomatic RSV episode. Probabilistic sensitivity analysis estimated that approximately 56% and 62% of simulations for Arexvy and Abrysvo were cost-effective at a $50,000/QALY gained threshold and an assumed negotiated base-case price of A$150 per dose.
Conclusions:
An RSV vaccination program for older Australians substantially reduced RSV hospitalisations, associated costs, and mortality. An RSV vaccination program is likely to be cost-effective in Australians aged ≥75 years if an appropriate vaccine price can be negotiated.
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