Cost-effectiveness of bivalent respiratory syncytial virus Prefusion F (RSVpreF) maternal vaccine among infants in the United States.
Background: Respiratory syncytial virus (RSV) is a leading cause of respiratory tract illness (RTI) among young children. The novel bivalent stabilized prefusion F subunit vaccine (RSVpreF) for pregnant people to protect their infants against RSV lower respiratory tract illness (RSV-LRTI) was recommended by the US Advisory Committee on Immunization Practices for use among pregnant persons between 32 and 36 weeks of gestation in September 2023. We evaluated the cost-effectiveness of maternal RSVpreF for prevention of RSV among US infants.
Methods: A cohort model was employed to depict clinical outcomes and economic costs of RSV from birth to age 1 year and lifetime consequences of premature RSV-related death. Cost-effectiveness of year-round and, alternatively, seasonally administered RSVpreF was evaluated compared to no intervention. Model inputs include RSV disease and case-fatality rates; vaccine effectiveness (derived from trial analyses); and costs of RSVpreF, RSV treatment, and caregiver work loss. Clinical outcomes (projected monthly) included cases of medically attended RSV, RSV-LRTI deaths, and quality-adjusted LYs (QALYs). Economic costs were generated based on vaccines administered as well as cases and corresponding unit costs and were reported in 2023 US$. Costs and benefits were discounted 3 % annually.
Results: Year-round maternal vaccination with RSVpreF resulted in a reduction of 13,349 hospitalizations, 32,414 emergency department encounters, and 96,540 outpatient clinic visits, corresponding with an increase in direct medical costs of $366 million and decrease in indirect (non-medical) costs of $80 million. With 2264 additional QALYs, the cost-effectiveness ratio was $89,733/QALY. Seasonal maternal vaccination prevented 23-39 % fewer cases (care setting dependent), but was cost saving overall, resulting in a dominant cost-effectiveness ratio.
Conclusions: Maternal vaccination with RSVpreF would substantially reduce the clinical and economic burden of RSV in infants, resulting in a cost-effectiveness ratio of $89,733 per QALY if administered year-round or cost savings if administered seasonally.