Centre for Immunization Programs, Public Health Agency of Canada, Ottawa, ON, Canada.
Centre for Immunization Programs, Public Health Agency of Canada, Ottawa, ON, Canada; Health Policy PhD Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Vaccine. 2024 Aug 30;42(21):126164. doi: 10.1016/j.vaccine.2024.126164. Epub 2024 Jul 30.
Health Canada recently authorized the RSVpreF pregnancy vaccine and nirsevimab to protect infants against respiratory syncytial virus (RSV) disease.
Assess the cost-effectiveness of RSVpreF and nirsevimab programs in preventing RSV disease in infants, compared to a palivizumab program.
We used a static cohort model of a Canadian birth cohort during their first RSV season to estimate sequential incremental cost-effectiveness ratios (ICERs) in 2023 Canadian dollars per quality-adjusted life year (QALY) for nine strategies implemented over a one-year time period, from the health system and societal perspectives. Sensitivity and scenario analyses were conducted to explore the impact of uncertainties on the results.
All-infants nirsevimab programs averted more RSV-related outcomes than year-round RSVpreF programs, with the most RSV cases averted in a seasonal nirsevimab program with catch-up. Assuming list prices for these immunizing agents, all-infants nirsevimab and year-round RSVpreF programs were never cost-effective, with ICERs far exceeding commonly used cost-effectiveness thresholds. Seasonal nirsevimab with catch-up for infants born outside the RSV season was a cost-effective program if prioritized for infants at moderate/high-risk (ICER <$28,000 per QALY) or those living in settings with higher RSV burden and healthcare costs, such as remote communities where transport would be complex (ICER of $5700 per QALY). Using a $50,000 per QALY threshold, an all-infants nirsevimab program could be optimal if nirsevimab is priced at <$110-190 per dose. A year-round RSVpreF for all pregnant women and pregnant people plus nirsevimab for infants at high-risk was optimal if nirsevimab is priced at >$110-190 per dose and RSVpreF priced at <$60-125 per dose.
Prophylactic interventions can substantially reduce RSV disease in infants, and more focused nirsevimab programs are the most cost-effective option at current product prices.
加拿大卫生部最近批准了 RSVpreF 孕期疫苗和 nirsevimab，以保护婴儿免受呼吸道合胞病毒（RSV）疾病的侵害。
评估 RSVpreF 和 nirsevimab 方案在预防婴儿 RSV 疾病方面的成本效益，与 palivizumab 方案相比。
我们使用加拿大一个出生队列的静态队列模型，在 RSV 季节期间估计了九个策略在 2023 年加元每质量调整生命年（QALY）的序贯增量成本效益比（ICER），这些策略在一年的时间内从卫生系统和社会角度实施。进行了敏感性和情景分析，以探讨不确定性对结果的影响。
所有婴儿 nirsevimab 方案比全年 RSVpreF 方案能预防更多的 RSV 相关结局，在季节性 nirsevimab 方案中，通过追赶免疫能预防最多的 RSV 病例。假设这些免疫制剂的定价，所有婴儿 nirsevimab 和全年 RSVpreF 方案都不是具有成本效益的，ICER 远远超过常用的成本效益阈值。对于出生在 RSV 季节之外的婴儿，季节性 nirsevimab 与追赶免疫是一种具有成本效益的方案，如果优先考虑中/高风险的婴儿（ICER<28000 加元/QALY）或那些生活在 RSV 负担和医疗保健成本较高的环境中的婴儿，例如交通复杂的偏远社区（每 QALY 成本效益为 5700 加元）。如果 nirsevimab 的价格低于 110-190 加元/剂，使用 50000 加元/QALY 的阈值，所有婴儿 nirsevimab 方案可能是最优的。如果 nirsevimab 的价格高于 110-190 加元/剂，RSVpreF 对所有孕妇和高风险孕妇以及婴儿进行全年接种，nirsevimab 的价格低于 60-125 加元/剂，则 RSVpreF 对所有孕妇和高风险孕妇以及婴儿进行全年接种是最优的。
预防干预措施可以显著降低婴儿 RSV 疾病的发生率，在当前产品价格下，更有针对性的 nirsevimab 方案是最具成本效益的选择。
