The upcoming RSV vaccine: Assessing the potential effectiveness and cost-effectiveness of different vaccination strategies in China

Abstract

Background Coinciding with the release of the respiratory syncytial virus (RSV) vaccines Arexvy and Abrysvo in Europe and the United States in 2023, and the clinical trials in China for Arexvy, we aimed to evaluate the cost-effectiveness of the diverse vaccination strategies in pregnant women, individuals aged 60, and those in the same age group at high risk with cardiovascular or respiratory diseases in China. Methods We did a cost-effectiveness analysis in China, in which we developed a decision-making model of RSV to evaluate the effectiveness and incremental cost-effectiveness ratios of 22 intervention strategies, including diverse vaccination coverages (25%, 50%, 75%) of Arexvy and Abrysvo, as well as scenarios without vaccination, from a health-care system perspective with four different scenarios of US vaccine costs (25%/50%/75%/100%). We performed both univariate sensitivity analysis and probabilistic sensitivity analysis to assess the robustness of the model’s findings. Results Compared with the absence of vaccination, various vaccination strategies would bring an additional cost of $-512.55-2719.8 million and 103.28-28811.06 Disability-Adjusted Life Years (DALYs) averted in the setting cohort over one year. With a willingness-to-pay threshold of three times of the Chinese per-capita gross domestic product (GDP), the most cost-effective strategy would be Abrysvo vaccination for 75% of pregnant women in all price settings with an incremental cost-effectiveness ratio of $-19116.29-21887.62 per DALY compared with no vaccination, and the cost-effectiveness frontier for all strategies further validated its dominance advantage. Consistent results were obtained in multiple extensive sensitivity analysis scenarios. Conclusion Priority vaccination for pregnant women was the most cost-effective strategy for RSV prevention in China. Additionally, a potentially low RSV vaccine price in China might simultaneously incentivize vaccination in elderly population, especially those at high risk. The findings furnished crucial evidence that informed the development of effective vaccination policies to combat RSV in China.