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Cost-Effectiveness of Respiratory Syncytial Virus Preventive Interventions in Children: A Model Comparison Study

Published:November 25, 2022DOI:https://doi.org/10.1016/j.jval.2022.11.014

      Highlights

      • Several static and dynamic cost-effectiveness models for respiratory syncytial virus (RSV) prevention interventions have been published, but these models used context-specific data and produce varied results.
      • The static and dynamic models produced similar estimated hospitalizations and deaths. The main differences can be explained by (1) model types and structures, (2) assumptions regarding nonmedically attended symptomatic RSV infections, and (3) waning assumptions for maternal vaccine and monoclonal antibody effectiveness.
      • Nonmedically attended cases’ quality-adjusted life-years and waning effectiveness of RSV interventions are influential and uncertain and should be explored in economic evaluations of RSV interventions.

      Abstract

      Objectives

      Model-based cost-effectiveness analyses on maternal vaccine (MV) and monoclonal antibody (mAb) interventions against respiratory syncytial virus (RSV) use context-specific data and produce varied results. Through model comparison, we aim to characterize RSV cost-effectiveness models and examine drivers for their outputs.

      Methods

      We compared 3 static and 2 dynamic models using a common input parameter set for a hypothetical birth cohort of 100 000 infants. Year-round and seasonal programs were evaluated for MV and mAb interventions, using available evidence during the study period (eg, phase III MV and phase IIb mAb efficacy).

      Results

      Three static models estimated comparable medically attended (MA) cases averted versus no intervention (MV, 1019-1073; mAb, 5075-5487), with the year-round MV directly saving ∼€1 million medical and €0.3 million nonmedical costs, while gaining 4 to 5 discounted quality-adjusted life years (QALYs) annually in <1-year-olds, and mAb resulting in €4 million medical and €1.5 million nonmedical cost savings, and 21 to 25 discounted QALYs gained. In contrast, both dynamic models estimated fewer MA cases averted (MV, 402-752; mAb, 3362-4622); one showed an age shift of RSV cases, whereas the other one reported many non-MA symptomatic cases averted, especially by MV (2014). These differences can be explained by model types, assumptions on non-MA burden, and interventions’ effectiveness over time.

      Conclusions

      Our static and dynamic models produced overall similar hospitalization and death estimates, but also important differences, especially in non-MA cases averted. Despite the small QALY decrement per non-MA case, their larger number makes them influential for the costs per QALY gained of RSV interventions.

      Keywords

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