Centre for Mathematics, Physics and Engineering in the Life Sciences and Experimental Biology, University College London, London, UK.
Department of Mathematics, University College London, London, UK.
BMC Med. 2020 Nov 18;18(1):348. doi: 10.1186/s12916-020-01802-8.
With a suite of promising new RSV prophylactics on the horizon, including long-acting monoclonal antibodies and new vaccines, it is likely that one or more of these will replace the current monoclonal Palivizumab programme. However, choosing the optimal intervention programme will require balancing the costs of the programmes with the health benefits accrued.
To compare the next generation of RSV prophylactics, we integrated a novel transmission model with an economic analysis. We estimated key epidemiological parameters by calibrating the model to 7 years of historical epidemiological data using a Bayesian approach. We determined the cost-effective and affordable maximum purchase price for a comprehensive suite of intervention programmes.
Our transmission model suggests that maternal protection of infants is seasonal, with 38-62% of infants born with protection against RSV. Our economic analysis found that to cost-effectively and affordably replace the current monoclonal antibody Palivizumab programme with long-acting monoclonal antibodies, the purchase price per dose would have to be less than around £4350 but dropping to £200 for vaccinated heightened risk infants or £90 for all infants. A seasonal maternal vaccine would have to be priced less than £85 to be cost-effective and affordable. While vaccinating pre-school and school-age children is likely not cost-effective relative to elderly vaccination programmes, vaccinating the elderly is not likely to be affordable. Conversely, vaccinating infants at 2 months seasonally would be cost-effective and affordable if priced less than £80.
In a setting with seasonal RSV epidemiology, maternal protection conferred to newborns is also seasonal, an assumption not previously incorporated in transmission models of RSV. For a country with seasonal RSV dynamics like England, seasonal programmes rather than year-round intervention programmes are always optimal.
随着一系列有前途的新 RSV 预防药物（包括长效单克隆抗体和新型疫苗）即将面世，其中一种或多种药物很可能取代当前的 Palivizumab 单克隆药物方案。然而，选择最佳干预方案需要平衡方案的成本与获得的健康效益。
为了比较下一代 RSV 预防药物，我们将一种新型传播模型与经济分析相结合。我们通过贝叶斯方法校准模型，使用 7 年的历史流行病学数据来估计关键的流行病学参数。我们确定了综合干预方案的具有成本效益和可负担的最高购买价格。
我们的传播模型表明，婴儿的母婴保护具有季节性，有 38-62%的婴儿出生时对 RSV 有保护作用。我们的经济分析发现，要以具有成本效益且负担得起的方式用长效单克隆抗体替代当前的单克隆抗体 Palivizumab 方案，每剂的购买价格必须低于 4350 英镑，但对于接种增强风险的婴儿降至 2000 英镑，或对于所有婴儿降至 90 英镑。季节性母体疫苗的价格必须低于 85 英镑才能具有成本效益和负担得起。虽然与老年人疫苗接种方案相比，为学龄前和学龄儿童接种疫苗不太具有成本效益，但为老年人接种疫苗不太可能负担得起。相反，如果定价低于 80 英镑，季节性为 2 个月大的婴儿接种疫苗将具有成本效益和负担得起。
在具有季节性 RSV 流行病学的环境中，新生婴儿的母婴保护也具有季节性，这是以前未纳入 RSV 传播模型的假设。对于像英格兰这样具有季节性 RSV 动态的国家，季节性方案始终优于全年干预方案。
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