Cost-effectiveness of respiratory syncytial virus vaccination for older adults: a modelling analysis
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Background
Evidence of the effectiveness and cost-effectiveness of new vaccines that reduce the burden of respiratory syncytial virus (RSV) in older populations is emerging. The reported cost-effectiveness of these vaccination strategies varies substantially across different settings. This study assessed the cost-effectiveness of older adult-targeted RSV vaccination strategies in the Australian context and compared findings with published evaluations.
Methods
We developed an individual-based dynamic transmission model of RSV infection, linked to a clinical pathways and cost-effectiveness model. We modelled different adult vaccination strategies for the general population and the Indigenous population, and present incremental cost-effectiveness ratios (ICERs) as cost per quality-adjusted life year gained, from a healthcare system perspective. Deterministic and probabilistic sensitivity analyses explored drivers of cost-effectiveness and sensitivity of findings to uncertainty in parameter estimates.
Results
Vaccinating the general population of older adults in Australia was not found to be cost-effective at a dose price of 100 AUD, but was found to be cost-saving for Indigenous adults, given the higher disease burden in this population. Individual drivers of ICERs in our setting were dose price, hospitalisation incidence and mortality, however conclusions about cost-effectiveness were robust to joint parameter uncertainty.
Conclusions
The cost-effectiveness of vaccinating adults against RSV depends on many uncertain and context-specific quantities. Strategies that target high risk populations were found to be cost-effective in Australia due to the larger avertable burden.
Key Summary Points
Why Carry Out This Study?
Respiratory syncytial virus (RSV) is a significant cause of respiratory illness and death, particularly in older adults, individuals with medical conditions, and Indigenous populations.
The reported cost-effectiveness of RSV vaccination strategies varies substantially across different settings.
With the Australian Government beginning to fund RSV vaccines from May 2026, this study aimed to provide timely, Australia-specific evidence on which vaccination strategies offer the greatest benefit relative to their cost.
What Was Learned from the Study?
A structured literature review confirmed substantial variability in how costs and benefits of RSV vaccination are evaluated across settings, underscoring the importance of context-specific evidence and transparent reporting when informing national vaccination policy decisions.
In our analysis, vaccinating Indigenous Australians aged 60 years and over was found to save money for the health system while also preventing hospitalisations and deaths, primarily because of the high burden of RSV in this population.
Vaccinating the broader older adult population was not found to be good value for money at the vaccine prices and willingness-to-pay thresholds assumed in this study.
The most influential drivers of cost-effectiveness were vaccine price and in-hospital case fatality rate - two factors that remain uncertain in the Australian context and warrant ongoing monitoring.
