Getaneh Abraham M, Li Xiao, Mao Zhuxin, Johannesen Caroline K, Barbieri Elisa, van Summeren Jojanneke, Wang Xin, Tong Sabine, Baraldi Eugenio, Phijffer Emily, Rizzo Caterina, van Wijhe Maarten, Heikkinen Terho, Bont Louis, Willem Lander, Jit Mark, Beutels Philippe, Bilcke Joke
Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), University of Antwerp, Belgium.
Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), University of Antwerp, Belgium.
Vaccine. 2023 Feb 24;41(9):1623-1631. doi: 10.1016/j.vaccine.2023.01.058. Epub 2023 Feb 1.
Respiratory syncytial virus (RSV) imposes a substantial burden on pediatric hospital capacity in Europe. Promising prophylactic interventions against RSV including monoclonal antibodies (mAb) and maternal immunizations (MI) are close to licensure. Therefore, we aimed to evaluate the cost-effectiveness of potential mAb and MI interventions against RSV in infants, for six European countries.
We used a static cohort model to compare costs and health effects of four intervention programs to no program and to each other: year-round MI, year-round mAb, seasonal mAb (October to April), and seasonal mAb plus a catch-up program in October. Input parameters were obtained from national registries and literature. Influential input parameters were identified with the expected value of partial perfect information and extensive scenario analyses (including the impact of interventions on wheezing and asthma).
From the health care payer perspective, and at a price of €50 per dose (mAb and MI), seasonal mAb plus catch-up was cost-saving in Scotland, and cost-effective for willingness-to-pay (WTP) values ≥€20,000 (England, Finland) or €30,000 (Denmark) per quality adjusted life-year (QALY) gained for all scenarios considered, except when using ICD-10 based hospitalization data. For the Netherlands, seasonal mAb was preferred (WTP value: €30,000-€90,000) for most scenarios. For Veneto region (Italy), either seasonal mAb with or without catch-up or MI was preferred, depending on the scenario and WTP value. From a full societal perspective (including leisure time lost), the seasonal mAb plus catch-up program was cost-saving for all countries except the Netherlands.
The choice between a MI or mAb program depends on the level and duration of protection, price, availability, and feasibility of such programs, which should be based on the latest available evidence. Future research should focus on measuring accurately age-specific RSV-attributable hospitalizations in very young children.
呼吸道合胞病毒（RSV）给欧洲儿科医院的收治能力带来了沉重负担。包括单克隆抗体（mAb）和母体免疫（MI）在内的有前景的RSV预防性干预措施已接近获批。因此，我们旨在评估针对六个欧洲国家婴儿的潜在mAb和MI干预措施预防RSV的成本效益。
我们使用静态队列模型，将四个干预项目与无干预项目以及各干预项目之间的成本和健康效果进行比较：全年MI、全年mAb、季节性mAb（10月至次年4月）以及季节性mAb加10月的补种项目。输入参数来自国家登记处和文献。通过部分完全信息的期望值和广泛的情景分析（包括干预措施对喘息和哮喘的影响）确定有影响的输入参数。
从医疗保健支付方的角度来看，以每剂50欧元（mAb和MI）的价格，季节性mAb加补种在苏格兰具有成本节约效果，对于所有考虑的情景，当意愿支付（WTP）值≥20,000欧元（英格兰、芬兰）或30,000欧元（丹麦）每获得一个质量调整生命年（QALY）时具有成本效益，但使用基于国际疾病分类第十版（ICD - 10）的住院数据时除外。在荷兰，大多数情景下首选季节性mAb（WTP值：30,000欧元 - 90,000欧元）。对于意大利威尼托地区，根据情景和WTP值，首选带或不带补种的季节性mAb或MI。从全社会角度（包括休闲时间损失）来看，除荷兰外，季节性mAb加补种项目对所有国家都具有成本节约效果。
MI或mAb项目的选择取决于此类项目的保护水平和持续时间、价格、可及性和可行性，而这些应基于最新可得证据。未来研究应专注于准确测量幼儿中特定年龄的RSV所致住院情况。
