Hodgson David, Wilkins Neil, van Leeuwen Edwin, Watson Conall H, Crofts Jonathan, Flasche Stefan, Jit Mark, Atkins Katherine E
Centre of Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.
UK Health Security Agency, London, UK.
Lancet Reg Health Eur. 2024 Jan 8;38:100829. doi: 10.1016/j.lanepe.2023.100829. eCollection 2024 Mar.
Two new products for preventing Respiratory Syncytial Virus (RSV) in young children have been licensed: a single-dose long-acting monoclonal antibody (la-mAB) and a maternal vaccine (MV). To facilitate the selection of new RSV intervention programmes for large-scale implementation, this study provides an assessment to compare the costs of potential programmes with the health benefits accrued.
Using an existing dynamic transmission model, we compared maternal vaccination to la-mAB therapy against RSV in England and Wales by calculating the impact and cost-effectiveness. We calibrated a statistical model to the efficacy trial data to accurately capture their immune waning and estimated the impact of seasonal and year-round programmes for la-mAB and MV programmes. Using these impact estimates, we identified the most cost-effective programme across pricing and delivery cost assumptions.
For infants under six months old in England and Wales, a year-round MV programme with 60% coverage would avert 32% (95% CrI 22-41%) of RSV hospital admissions and a year-round la-mAB programme with 90% coverage would avert 57% (95% CrI 41-69%). The MV programme has additional health benefits for pregnant women, which account for 20% of the population-level health burden averted. A seasonal la-mAB programme could be cost-effective for up to £84 for purchasing and administration (CCPA) and a seasonal MV could be cost-effective for up to £80 CCPA.
This modelling and cost-effectiveness analysis has shown that both the long-acting monoclonal antibodies and the maternal vaccine could substantially reduce the burden of RSV disease in the infant population. Our analysis has informed JCVI's recommendations for an RSV immunisation programme to protect newborns and infants.
National Institute for Health Research.
两种用于预防幼儿呼吸道合胞病毒（RSV）的新产品已获许可：一种单剂量长效单克隆抗体（la-mAB）和一种母体疫苗（MV）。为便于选择新的RSV干预方案以进行大规模实施，本研究进行了评估，以比较潜在方案的成本与所产生的健康效益。
我们使用现有的动态传播模型，通过计算影响和成本效益，将英格兰和威尔士的母体疫苗接种与针对RSV的la-mAB疗法进行了比较。我们根据疗效试验数据校准了一个统计模型，以准确捕捉其免疫减弱情况，并估计了la-mAB和MV方案的季节性和全年性方案的影响。利用这些影响估计值，我们在定价和交付成本假设范围内确定了最具成本效益的方案。
对于英格兰和威尔士6个月以下的婴儿，覆盖率为60%的全年MV方案可避免32%（95%可信区间22%-41%）的RSV住院病例，覆盖率为90%的全年la-mAB方案可避免57%（95%可信区间41%-69%）。MV方案对孕妇还有额外的健康益处，这占避免的人群水平健康负担的20%。季节性la-mAB方案的采购和管理成本效益最高可达84英镑（CCPA），季节性MV方案的采购和管理成本效益最高可达80英镑（CCPA）。
该建模和成本效益分析表明，长效单克隆抗体和母体疫苗都可大幅减轻婴儿群体中RSV疾病的负担。我们的分析为联合疫苗接种和免疫联合委员会（JCVI）关于保护新生儿和婴儿的RSV免疫方案的建议提供了依据。
英国国家卫生研究院。
