Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA.
Vaccine. 2024 Oct 24;42(24):126294. doi: 10.1016/j.vaccine.2024.126294. Epub 2024 Sep 5.
Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in older adults. In May 2023, two subunit RSV vaccines (Arexvy [GSK] and Abrysvo [Pfizer]) received approval from the U.S. Food and Drug Administration (FDA). In June 2023, ACIP recommended that adults aged ≥60 years may receive a single dose of RSV vaccine, using shared clinical decision-making. In support of development of this policy, our objective was to assess the cost-effectiveness of RSV vaccination in the general population in this age group. We used a decision-analytical model of RSV over a two-year timeframe using data from published literature, FDA documents, epidemiological databases, and manufacturer data. We tracked RSV-associated outpatient, emergency department, inpatient healthcare utilization, RSV-attributable deaths, quality-adjusted life-years lost (QALYs), and societal costs. The societal cost per QALY saved from RSV vaccination depended on age group and product: adults aged ≥60 years, $196,842 for GSK's vaccine and $176,557 for Pfizer's vaccine; adults ≥65 years, $162,138 for GSK and $146,543 for Pfizer; adults 60- <65 years, $385,829 for GSK and $331,486 for Pfizer. Vaccine efficacy, incidence of RSV hospitalization, and vaccine cost had the greatest influence on cost per QALY. Cost per QALY saved decreased as the age of those vaccinated increased. Inputs such as long-term efficacy are uncertain. RSV vaccination in adults aged ≥60 years may be cost-effective, particularly in those of more advanced age. Lower vaccine acquisition costs and persistent efficacy beyond two RSV seasons would render RSV vaccination more cost-effective for a broader target population. PRIMARY FUNDING SOURCE: US Centers for Disease Control and Prevention.
呼吸道合胞病毒（RSV）可导致老年人发病率和死亡率大幅上升。2023 年 5 月，两种亚单位 RSV 疫苗（Arexvy[葛兰素史克]和 Abrysvo[辉瑞]）获得美国食品和药物管理局（FDA）批准。2023 年 6 月，免疫实践咨询委员会（ACIP）建议≥60 岁的成年人可以使用共享临床决策，接种单剂 RSV 疫苗。为支持该政策的制定，我们旨在评估该年龄组人群中 RSV 疫苗接种的成本效益。我们在为期两年的时间内使用来自已发表文献、FDA 文件、流行病学数据库和制造商数据的 RSV 数据，建立了 RSV 的决策分析模型。我们跟踪了与 RSV 相关的门诊、急诊、住院医疗利用、由 RSV 导致的死亡、质量调整生命年（QALY）损失和社会成本。从 RSV 疫苗接种中每节省一个 QALY 的社会成本取决于年龄组和产品：≥60 岁的成年人，GSK 疫苗为 196842 美元，辉瑞疫苗为 176557 美元；≥65 岁的成年人，GSK 疫苗为 162138 美元，辉瑞疫苗为 146543 美元；60-<65 岁的成年人，GSK 疫苗为 385829 美元，辉瑞疫苗为 331486 美元。疫苗效力、RSV 住院发生率和疫苗成本对每 QALY 的成本影响最大。随着接种人群年龄的增加，每 QALY 节省的成本呈下降趋势。长期疗效等投入因素存在不确定性。对于≥60 岁的成年人进行 RSV 疫苗接种可能具有成本效益，尤其是对于年龄较大的人群。降低疫苗获取成本和 RSV 季节之外持续的有效性将使更广泛的目标人群接种 RSV 疫苗更具成本效益。主要资金来源：美国疾病控制与预防中心。
