Cost of delivering childhood RSV prevention interventions to the health system in Kenya: a prospective analysis

Objectives: To evaluate the cost of delivering childhood respiratory syncytial virus (RSV) prevention interventions to the health system in Kenya.

Design: A prospective (cost projection) activity-based costing study.

Setting: Kenya, national introduction of interventions.

Participants: Not applicable.

Interventions: A single-dose RSV maternal vaccine and a single-dose, long-acting monoclonal antibody (mAb).

Primary and secondary outcome measures: Cost per eligible target population; cost per dose administered; non-commodity cost of delivery. Costs are reported in 2023 USD.

Results: RSV interventions are expected to be delivered using existing systems: maternal vaccine using the antenatal care platform and the mAb delivered similar to existing birth dose vaccines. Assuming a price of US$3 per dose (for both interventions) and baseline coverage rates averaging 50% for the maternal vaccine and 86% for the mAb, the estimated cost of delivering maternal vaccine was US$1.74 (financial) and US$6.60 (economic) per vaccinated woman, and the cost of delivering mAbs was US$1.56 (financial) and US$6.27 (economic) per vaccinated child. Excluding commodity cost, the cost of delivering maternal vaccine was US$1.32 (financial) and US$2.72 (economic) and that for mAb was US$1.23 (financial) and US$2.48 (economic). Cost differences between the two interventions are driven by the anticipated baseline coverage. Health worker training, service delivery and programme planning and coordination were major cost drivers.

Conclusion: This study presents the prospective cost of new RSV intervention introduction and delivery in low-income and middle-income country settings, which is largely unknown. Cost estimates incorporate anticipated health system strengthening activities needed to deliver the future RSV interventions. These cost estimates support country-level and global-level decision-makers evaluating implementation feasibility and intervention affordability.