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Published on: January 26, 2019
Cost-Effectiveness of Maternal RSVpreF Vaccination Compared with Newborn Nirsevimab RSV Prophylaxis or No RSV
Jamie Bainbridge1, Stuart Mealing1, Charlotte Graham1
1York Health Economics Consortium, Enterprise House, Innovation Way, University of York, York, YO10 5NQ, UK.
Insights
Maternal immunization with RSVpreF is cost-effective for infant protection against respiratory syncytial virus (RSV). This vaccine offers value compared to no prophylaxis and is now reimbursed in Switzerland.
Area of Science:
- Health Economics
- Vaccinology
- Public Health
Background:
- Respiratory syncytial virus (RSV) causes significant lower respiratory tract infections in infants.
- RSVpreF is a maternal vaccine for passive infant protection against RSV in Switzerland.
Purpose of the Study:
- To conduct a health technology assessment (HTA) of RSVpreF for maternal vaccination in Switzerland.
- To evaluate the cost-effectiveness of RSVpreF compared to nirsevimab or no RSV prophylaxis.
Main Methods:
- A Markov model with a 1-year time horizon and 1-month cycles was utilized.
- The model adopted a Swiss healthcare payer perspective, incorporating a 3% discount rate.
- Health outcomes were measured in quality-adjusted life years (QALYs), with sensitivity analyses performed.
Main Results:
- RSVpreF was associated with reduced costs and QALYs compared to nirsevimab (ICER: CHF 536,008/QALY).
- Compared to no prophylaxis, RSVpreF increased costs and QALYs (ICER: CHF 17,377/QALY).
Conclusions:
- RSVpreF demonstrates high cost-effectiveness against both nirsevimab and no prophylaxis at plausible threshold values.
- Model findings informed updated Swiss guidance, leading to RSVpreF reimbursement by mandatory health insurance.
Background:
RSVpreF is a vaccine that immunises against respiratory syncytial virus (RSV), a seasonal respiratory virus, that can lead to lower respiratory tract infections. In Switzerland, RSVpreF is indicated for the passive protection of infants against RSV following maternal immunisation.
Objective:
The Swiss Federal Office of Public Health commissioned a health technology assessment (HTA) of RSVpreF for maternal vaccination, evaluating the clinical and cost effectiveness of the vaccine compared with nirsevimab (administered directly to newborns and infants) or no RSV prophylaxis. This study reports the cost-effectiveness model developed for the Swiss HTA.
Methods:
The model used a Markov model structure, a 1-year time horizon, a one-month cycle length, a Swiss healthcare payers' perspective, and a 3% discount rate for costs and health benefits. Health states included no RSV infection, RSV infection leading to hospitalisation, primary care visits or emergency department visits, post-RSV infection, and death. MATISSE informed RSVpreF efficacy, and MELODY and HARMONIE informed nirsevimab efficacy. Health outcomes were expressed as quality-adjusted life years (QALYs). Probabilistic and deterministic sensitivity analyses were undertaken to explore the impact of parameter uncertainty on the model results.
Results:
When compared with nirsevimab, RSVpreF reduces total costs (CHF -9,878,738) and QALYs (-18.4), with an incremental cost-effectiveness ratio (ICER) of 536,008 per QALY (N = 38,844). Compared with no RSV prophylaxis, RSVpreF increases total costs (CHF +470,441) and QALYs (+27.1), with an ICER of 17,377 per QALY (N = 38,844).
Conclusions:
RSVpreF is highly likely to be cost-effective versus both comparators at a range of plausible threshold values. The results of the model contributed to guidance updates in Switzerland, with RSVpreF now reimbursed by mandatory health insurance.
