Cost-effectiveness of RSVpreF vaccine and nirsevimab for the prevention of respiratory syncytial virus disease in Canadian infants

Gebremedhin B Gebretekle; Man Wah Yeung; Raphael Ximenes; Alexandra Cernat; Alison E Simmons; April Killikelly; Winnie Siu; Ellen Rafferty; Nicholas Brousseau; Matthew Tunis; Ashleigh R Tuite

doi:10.1016/j.vaccine.2024.126164

Cost-effectiveness of RSVpreF vaccine and nirsevimab for the prevention of respiratory syncytial virus disease in Canadian infants

Vaccine. 2024 Aug 30;42(21):126164. doi: 10.1016/j.vaccine.2024.126164. Epub 2024 Jul 30.

Affiliations

¹ Centre for Immunization Programs, Public Health Agency of Canada, Ottawa, ON, Canada.
² Centre for Immunization Programs, Public Health Agency of Canada, Ottawa, ON, Canada; Health Policy PhD Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
³ Centre for Immunization Programs, Public Health Agency of Canada, Ottawa, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁴ Centre for Immunization Programs, Public Health Agency of Canada, Ottawa, ON, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁵ Institute of Health Economics, Edmonton, AB, Canada; Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
⁶ Biological Risks Unit, Institut national de santé publique du Québec, Québec, Canada; Department of Social and Preventive Medicine, Université Laval, Québec, Canada.
⁷ Centre for Immunization Programs, Public Health Agency of Canada, Ottawa, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. Electronic address: [email protected].

PMID: 39079810
DOI: 10.1016/j.vaccine.2024.126164

Abstract

Background: Health Canada recently authorized the RSVpreF pregnancy vaccine and nirsevimab to protect infants against respiratory syncytial virus (RSV) disease.

Objective: Assess the cost-effectiveness of RSVpreF and nirsevimab programs in preventing RSV disease in infants, compared to a palivizumab program.

Methods: We used a static cohort model of a Canadian birth cohort during their first RSV season to estimate sequential incremental cost-effectiveness ratios (ICERs) in 2023 Canadian dollars per quality-adjusted life year (QALY) for nine strategies implemented over a one-year time period, from the health system and societal perspectives. Sensitivity and scenario analyses were conducted to explore the impact of uncertainties on the results.

Results: All-infants nirsevimab programs averted more RSV-related outcomes than year-round RSVpreF programs, with the most RSV cases averted in a seasonal nirsevimab program with catch-up. Assuming list prices for these immunizing agents, all-infants nirsevimab and year-round RSVpreF programs were never cost-effective, with ICERs far exceeding commonly used cost-effectiveness thresholds. Seasonal nirsevimab with catch-up for infants born outside the RSV season was a cost-effective program if prioritized for infants at moderate/high-risk (ICER <$28,000 per QALY) or those living in settings with higher RSV burden and healthcare costs, such as remote communities where transport would be complex (ICER of $5700 per QALY). Using a $50,000 per QALY threshold, an all-infants nirsevimab program could be optimal if nirsevimab is priced at <$110-190 per dose. A year-round RSVpreF for all pregnant women and pregnant people plus nirsevimab for infants at high-risk was optimal if nirsevimab is priced at >$110-190 per dose and RSVpreF priced at <$60-125 per dose.

Interpretation: Prophylactic interventions can substantially reduce RSV disease in infants, and more focused nirsevimab programs are the most cost-effective option at current product prices.

Keywords: Cost-effectiveness; Cost-utility; Nirsevimab; RSV; RSVpreF.

MeSH terms

Antibodies, Monoclonal, Humanized* / economics
Antibodies, Monoclonal, Humanized* / therapeutic use
Antiviral Agents / economics
Antiviral Agents / therapeutic use
Canada
Cost-Benefit Analysis*
Female
Humans
Infant
Infant, Newborn
Male
Palivizumab* / economics
Palivizumab* / therapeutic use
Quality-Adjusted Life Years*
Respiratory Syncytial Virus Infections* / economics
Respiratory Syncytial Virus Infections* / prevention & control
Respiratory Syncytial Virus Vaccines* / administration & dosage
Respiratory Syncytial Virus Vaccines* / economics
Respiratory Syncytial Virus Vaccines* / therapeutic use
Respiratory Syncytial Virus, Human / drug effects
Respiratory Syncytial Virus, Human / immunology

Substances

Respiratory Syncytial Virus Vaccines
Antibodies, Monoclonal, Humanized
Palivizumab
Antiviral Agents
motavizumab