Modeling study finds RSV vaccines cost-effective for older U.S. adults

Vaccination programs using the monovalent adjuvanted or bivalent vaccine against respiratory syncytial virus (RSV) were projected to be potentially cost-effective at a price per dose of up to $127 or up to $118, respectively, over a first RSV season.

Both FDA-approved vaccines against respiratory syncytial virus (RSV) were found to be cost-effective at specific prices per dose (PPD) in a recent modeling study.

Researchers used a discrete-event simulation model to calculate the net monetary benefit of the monovalent and bivalent RSV vaccines, accounting for the costs associated with RSV disease, including outpatient care, hospitalization, and death, as well as adverse events associated with vaccination. The model was based on a population of 100,000 adults reflecting U.S. demographics and stratified into age groups of 60 to 64 years, 65 to 69 years, 70 to 74 years, 75 to 79 years, 80 to 84 years, and 85 years or older. Quality-adjusted life-years (QALYs) gained was used as a measure of vaccine effectiveness, and the PPD required for vaccination programs to be considered cost-effective was determined for each vaccine. The monovalent adjuvanted vaccine, Arexvy, is manufactured by GSK, and the bivalent vaccine, Abrysvo, is manufactured by Pfizer. The results were published Nov. 30 by Clinical Infectious Diseases.

With a willingness-to-pay threshold of $95,000 per QALY gained, the modeling study found that vaccination programs could be cost-effective for a PPD of up to $127 with Arexvy and up to $118 with Abrysvo over a first RSV season. If RSV vaccine coverage is projected to reach 66% among older U.S. adults, similar to that of influenza, RSV vaccination programs at the maximum PPD would have budget impacts ranging from $6.48 to $6.78 billion over one RSV season. If vaccine benefits extend to a second season, the estimated maximum PPD would be $235 for Arexvy and $245 for Abrysvo, with estimated two-year budget impacts of $11.78 and $12.25 billion, respectively, the study found.

The researchers noted that they did not account for more severe adverse vaccine reactions, which may have affected PPD estimates, or potential sequelae of RSV infection beyond two years, among other limitations. In addition, they said, their study assumes that most older adults can afford to access the vaccines, so their real-world impact will depend on coverage decisions by Medicare, Medicaid, and other payers. “In conclusion, our study shows that vaccination against RSV-associated [lower respiratory tract disease] could be cost-effective and reduce the burden of illness substantially among older adults,” they wrote. “Additional evidence of vaccine effectiveness at the population level would be required to alleviate uncertainty on longer-term health benefits and cost-effectiveness of vaccination beyond a single RSV season.”