Cost-effectiveness of immunising interventions to reduce respiratory syncytial virus disease burden in infants in Australia
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Background
Two immunising products are emerging to prevent the burden of respiratory syncytial virus (RSV) in infants: long-lasting monoclonal antibodies (mAbs) and maternal vaccines given during pregnancy (MV). This study assesses the potential cost-effectiveness of programs involving each product, to help inform policy decisions related to their implementation in the Australian context.
Methods
We developed an individual-based dynamic transmission model of RSV infection, linked to a clinical pathways model and cost-effectiveness model. We modelled key scenarios exploring varying eligibility and coverage of immunisation products for at-risk and not-at-risk populations, in addition to sensitivity analyses of immunisation characteristics, program costs, and the impact of potential under-ascertainment of RSV burden. We estimated the cost-effectiveness of each program from a health system perspective, with results presented as incremental cost-effectiveness ratios in terms of cost per quality-adjusted life year gained (QALY).
Findings
We found a combined program in which administration of MV during pregnancy is supplemented with a birth-dose of mAbs for newborns born without protection from MV is likely to be cost-saving, compared to the status quo of no MV or mAbs delivered. This program averted on average 41% of infant hospitalisations per year and reduced QALY losses by 33%.
Interpretation
Programs combining infant immunisation products are likely to significantly reduce the burden of RSV disease in Australia, and be cost-saving. However, their estimated impact and cost-effectiveness is strongly dependent on key assumptions i) the consistency and completeness of ascertainment of disease burden over time; ii) the cost of a hospitalisation and immunising dose; iii) the efficacy and durability of protection of the modelled products, and; iv) the timing and coverage of the immunisation delivery.
Funding
This modelling was commissioned by the National Immunisation Division of the Australian Government Department of Health, Disability and Ageing.
