RTI Health Solutions, 3040 East Cornwallis Road, Research Triangle Park, NC 27709-2194, USA.
RTI Health Solutions, 3040 East Cornwallis Road, Research Triangle Park, NC 27709-2194, USA.
Vaccine. 2022 Jan 24;40(3):483-493. doi: 10.1016/j.vaccine.2021.12.002. Epub 2021 Dec 20.
Respiratory syncytial virus (RSV) is an important cause of lower respiratory infections and hospitalizations among older adults. We aimed to estimate the potential clinical benefits and economic value of RSV vaccination of older adults in the United States (US).
We developed an economic model using a decision-tree framework to capture outcomes associated with RSV infections in US adults aged ≥ 60 years occurring during one RSV season for a hypothetical vaccine versus no vaccine. Two co-base-case epidemiology sources were selected from a targeted review of the US literature: a landmark study capturing all RSV infections and a contemporary study reporting medically attended RSV that also distinguishes mild from moderate-to-severe disease. Both base-case analyses used recent data on mortality risk in the year after RSV hospitalizations. Direct medical costs and quality-adjusted life-years (QALYs) lost per case were obtained from the literature and publicly available sources. Model outcomes included the population-level clinical and economic RSV disease burden among older adults, potential vaccine-avoidable disease burden, and the potential value-based price of a vaccine from a third-party payer perspective.
Our two base-case analyses estimated that a vaccine with 50% efficacy and coverage matching that of influenza vaccination would prevent 43,700-81,500 RSV hospitalizations and 8,000-14,900 RSV-attributable deaths per RSV season, resulting in 1,800-3,900 fewer QALYs lost and avoiding $557-$1,024 million. Value-based prices for the co-base-case analyses were $152-$299 per vaccination at a willingness to pay of $100,000/QALY gained. Sensitivity analyses found that the economic value of vaccination was most sensitive to RSV incidence and increased posthospitalization mortality risks.
Despite variability and gaps in the epidemiology literature, this study highlights the potential value of RSV vaccination for older adults in the US. Our analysis provides contemporary estimates of the population-level RSV disease burden and insights into the economic value drivers for RSV vaccination.
呼吸道合胞病毒（RSV）是导致老年人下呼吸道感染和住院的重要原因。我们旨在评估在美国（US）对老年人进行 RSV 疫苗接种的潜在临床获益和经济价值。
我们使用决策树框架开发了一个经济模型，以捕获与 US 60 岁以上成年人在一个 RSV 季节中发生的 RSV 感染相关的结果。对于假设的疫苗与无疫苗，使用两种共同基本案例流行病学来源进行了研究：一项具有里程碑意义的研究捕获了所有 RSV 感染，另一项当代研究报告了需要医疗治疗的 RSV，还区分了轻度和中度至重度疾病。这两个基本案例分析都使用了最近关于 RSV 住院后一年内死亡率的数据。每例疾病的直接医疗成本和质量调整生命年（QALY）损失均从文献和公开来源获得。模型结果包括老年人中 RSV 疾病的人群水平临床和经济负担、潜在的疫苗可预防疾病负担以及从第三方支付者角度来看疫苗的潜在价值为基础的价格。
我们的两个基本案例分析估计，一种具有 50%疗效和与流感疫苗接种相匹配的疫苗覆盖率，将预防 43700-81500 例 RSV 住院治疗和 8000-14900 例 RSV 归因死亡，从而减少 1800-3900 个 QALY 损失，并避免 5570-10240 万美元的损失。共同基本案例分析的基于价值的价格为每次接种 152-299 美元，在愿意支付 100000 美元/QALY 获得的情况下。敏感性分析发现，疫苗接种的经济价值对 RSV 发病率和增加的住院后死亡率风险最为敏感。
尽管在流行病学文献中存在变异性和差距，但本研究强调了 RSV 疫苗接种对 US 老年人的潜在价值。我们的分析提供了 RSV 疾病负担的人群水平的最新估计，并深入了解了 RSV 疫苗接种的经济价值驱动因素。
