Burden of paediatric respiratory syncytial virus disease and potential effect of different immunisation strategies: a modelling and cost-effectiveness analysis for England

Abstract

SummaryBackgroundVaccines and prophylactic antibodies against respiratory syncytial virus (RSV) are in development and likely to be available in the next 5–10 years. The most efficient way to use these products when they become available is an important consideration for public health decision makers.MethodsWe performed a multivariate regression analysis to estimate the burden of RSV in children younger than 5 years in England (UK), a representative high-income temperate country, and used these results to assess the potential effect of different RSV immunisation strategies (targeting vaccination for infants, or pregnant women, or prophylactic antibodies for neonates). We did a cost-effectiveness analysis for these strategies, implemented either separately or concurrently, and assessed the effect of restricting vaccination to certain months of the year.FindingsWe estimated that RSV is responsible for 12 primary care consultations (95% CI 11·9–12·1) and 0·9 admissions to hospital annually per 100 children younger than 5 years (95% CI 0·89–0·90), with the major burden occurring in infants younger than 6 months. The most cost-effective strategy was to selectively immunise all children born before the start of the RSV season (maximum price of £220 [95% uncertainty interval (UI) 208–232] per vaccine, for an incremental cost-effectiveness ratio of £20 000 per quality-adjusted life-year). The maximum price per fully protected person that should be paid for the infant, newborn, and maternal strategies without seasonal restrictions was £192 (95% UI 168–219), £81 (76–86), and £54 (51–57), respectively.InterpretationNearly double the number of primary care consultations, and nearly five times the number of admissions to hospital occurred with RSV compared with influenza. RSV vaccine and antibody strategies are likely to be cost-effective if they can be priced below around £200 per fully protected person. A seasonal vaccination strategy is likely to provide the most direct benefits. Herd effects might render a year-round infant vaccination strategy more appealing, although it is currently unclear whether such a programme would induce herd effects.FundingUK National Institute for Health Research.

Health and economic burden of respiratory syncytial virus (RSV) disease and the cost-effectiveness of potential interventions against RSV among children under 5 years in 72 Gavi-eligible countries

“…A multi-country RSV impact model, MCMARCEL (Multi-Country Model Application for RSV Cost-Effectiveness poLicy), was developed in the R environment (https://www.rproject.org/), based on the concept of a published singlecountry static cohort model [12]. It follows a cohort of children monthly from birth to 5 years of age.…”

“…In the base case, we used the WHO preferred product characteristics and other literature to assume 70% efficacy (range 50-90% for scenario analysis) for both the maternal vaccine and mAb among the newborns [12,15,25,26]. Recently, topline results of the first RSV maternal immunisation phase 3 trial (Prepare™) have been made public, and we applied the data in the scenario analyses.…”

Age‐specific incidence rates and risk factors for respiratory syncytial virus‐associated lower respiratory tract illness in cohort children under 5 years old in the Philippines

“…Fast breathing is one of the criteria for LRTI, and the cut-off points differ by age (50 breaths/min in children aged 2-11 months and 40 breaths/min in children aged 12-59 months 25 [11,42] 19 [11,30] 16 [10,23] 12 [6,17] 18 [10,27] 15 [9,22] 19 [10,31] Age in months, n (%) 2-5…”

“…For these reasons, it is believed that natural maternal immunity is not enough to prevent severe RSV‐LRTI in early infancy. Different strategies for vaccination, including maternal vaccination and infant vaccination, have been proposed to prevent severe infection . However, effective implementation of these strategies depends on understanding the epidemiological patterns of severe infections, including age‐specific incidences.…”

Vaccine Update: Recent Progress With Novel Vaccines, and New Approaches to Safety Monitoring and Vaccine Shortage

“…Stakeholders, including scientists, academicians, industry, funders, and regulators, are invested in the development of safe and effective novel antibodies and vaccines for the prevention of RSV infection in high-risk populations, including infants in the first few months of life, as the main intervention strategy to reduce the burden and impact of RSV globally. [58][59][60] Treatment Options for RSV Currently, supportive care is the mainstay of the management of infants and young children with RSV bronchiolitis. 61 Administration of oxygen and maintaining an adequate hydration status are recommended in most patients who require medical attention, while some patients with severe disease may require different levels of mechanical ventilatory support.…”