By Ethan Covey
Vaccination with the RSV bivalent prefusion F maternal vaccine (RSVpreF ; Abrysvo, Pfizer) and the use of the monoclonal antibody nirsevimab (Beyfortus, Sanofi) are cost-effective options for preventing respiratory syncytial virus among infants and children, according to a pair of studies conducted by a team of health economists (Pediatrics 2024;154[6]:e2024066481).
It has been estimated that the disease burden of RSV costs $472 million per year in the United States (J Infect Dis 2022;226[suppl 2]:S225-S235). While both RSVpreF and nirsevimab have been shown to protect infants and/or children from RSV, their costs are high, leading to discussion regarding the products’ cost-effectiveness.
“Both these new products are relatively expensive, so it’s important to evaluate not only the health benefits but also the increased spending,” lead author David W. Hutton, PhD, a professor and an associate chair of health management and policy at the University of Michigan School of Public Health, in Ann Arbor, told Infectious Disease Special Edition.
RSVpreF is given between 32 and 36 weeks of pregnancy to provide protection to the infant. The researchers aimed to evaluate the projected impact of year-round and seasonal maternal vaccination with RSVpreF by using an analytical model of short- and long-term impacts of RSV disease comparing no vaccination with seasonal maternal vaccination over one year.
RSVpreF, which was approved by the FDA in August 2023, has been estimated to cost $295 per dose. The analysis determined that year-round maternal vaccination of half of the pregnant people with RSVpreF during 32 through 36 weeks’ gestation will decrease RSV-related medical events but increase societal costs. RSVpreF has the potential to be cost-effective under certain conditions and in specific situations, the authors emphasized. However, they noted that the seasonal timing of vaccine receipt had a substantial effect on the incremental cost-effectiveness ratio.
In evaluating the cost-effectiveness of nirsevimab, the team created an analytical model that used secondary data to simulate the short- and long-term effects of RSV on infants with and without nirsevimab.
They determined that while the cost-effectiveness of administering nirsevimab to infants is sensitive to a variety of factors, its use to prevent medically attended RSV lower respiratory tract infection in infants and young children is likely to sizably decrease the RSV disease burden. They estimated a societal cost of $153 ,517 per quality-adjusted life-year gained if nirsevimab is given to infants younger than 8 months of age before entering their first RSV season.
“We think the benefits in terms of reduced hospitalizations and healthcare visits are likely worth the costs for either of these products, if given at the right time,” Dr. Hutton said.
“One thing that we can’t answer yet is how to think about these new products in combination,” he added. “They were tested independently, so we do not know how they might work together. With that said, the marginal benefit of layering one on top of the other (e.g., giving nirsevimab to a baby born to a mother who received maternal vaccination) may not be very big to justify the additional spending.”
