Nazareno Allen L, Wood James G, Muscatello David J, Homaira Nusrat, Hogan Alexandra B, Newall Anthony T
School of Population Health, Faculty of Medicine and Health, UNSW Sydney, New South Wales, Australia; Institute of Mathematical Sciences, College of Arts and Sciences, University of the Philippines Los Baños, Laguna, Philippines.
School of Population Health, Faculty of Medicine and Health, UNSW Sydney, New South Wales, Australia.
Vaccine. 2025 Feb 6;46:126651. doi: 10.1016/j.vaccine.2024.126651. Epub 2024 Dec 28.
Respiratory syncytial virus (RSV) is a major cause of respiratory illness, with younger infants at greatest risk of hospitalisation. With the recent approval of a maternal RSV vaccine in Australia, it is timely to evaluate its potential costs and health benefits in Australia.
We applied an integrated dynamic and economic evaluation model to estimate specific outcomes of RSV disease and the cost-effectiveness of a year-round maternal RSV vaccination program in Australia. Cost-effectiveness was estimated using the incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained.
From a healthcare system perspective, the maternal vaccination program was estimated to be cost-effective at a vaccine price less than approximately 120 Australian dollars ($AU), assuming a willingness-to-pay (WTP) threshold of $AU 50,000/QALY gained. Most of the estimated cost-savings were from preventing RSV hospitalisations in infants aged <6 months. However, while 82% of the cost-savings were from preventing RSV hospitalisations in infants aged <6 months, only about 25% of the QALY gains were in this age group. The majority of the other QALY gains came via herd effects from prevention of death in older adults and to a lesser extent, prevention of nonmedically-attended illness in older teens and adults. When predicted cost-savings and QALY gains in those ≥6 months of age were excluded, the vaccine price required to meet the assumed WTP threshold fell to $AU 63.
A maternal RSV vaccination program in Australia could provide value for money by reducing hospitalisations and associated costs among infants aged <6 months, depending on the vaccine price. We have provided evidence that herd effects beyond the target population may be an important consideration in assessing cost-effectiveness of maternal RSV vaccination.
呼吸道合胞病毒（RSV）是引起呼吸道疾病的主要原因，年龄较小的婴儿住院风险最高。随着澳大利亚近期批准了一种母体RSV疫苗，及时评估其在澳大利亚的潜在成本和健康效益很有必要。
我们应用了一个综合动态和经济评估模型，以估计RSV疾病的具体结果以及澳大利亚全年母体RSV疫苗接种计划的成本效益。使用每获得一个质量调整生命年（QALY）的增量成本效益比（ICER）来估计成本效益。
从医疗保健系统的角度来看，假设每获得一个QALY的支付意愿（WTP）阈值为50,000澳元，当疫苗价格低于约120澳元时，母体疫苗接种计划估计具有成本效益。估计的大部分成本节省来自预防6个月以下婴儿的RSV住院。然而，虽然82%的成本节省来自预防6个月以下婴儿的RSV住院，但该年龄组仅获得约25%的QALY增益。其他大部分QALY增益来自预防老年人死亡的群体效应，在较小程度上来自预防青少年和成年人的非医疗就诊疾病。当排除6个月及以上人群预测的成本节省和QALY增益时，达到假设的WTP阈值所需的疫苗价格降至63澳元。
澳大利亚的母体RSV疫苗接种计划可通过减少6个月以下婴儿的住院率和相关成本来提供性价比，这取决于疫苗价格。我们提供的证据表明，目标人群之外的群体效应可能是评估母体RSV疫苗接种成本效益时的一个重要考虑因素。
