Introduction <p>Germany’s Standing Committee on Vaccination (STIKO) recommends the use of monoclonal antibody nirsevimab for infants in their first respiratory syncytial virus (RSV) season; however, incorporating RSVpreF maternal vaccination may protect more infants while lowering healthcare costs. We therefore evaluated the cost-effectiveness of a complementary immunization approach comprising maternal RSVpreF vaccination during pregnancy and nirsevimab for infants not yet protected to prevent lower respiratory tract disease due to RSV (RSV-LRTD) among infants in Germany.</p> Methods <p>Clinical and economic outcomes of RSV-LRTD and the expected impact of interventions were modeled from birth to age &lt; 1&#xa0;year. Model inputs were based on German data as available. Intervention strategies included no intervention, nirsevimab alone (N-all; uptake 70%), and the complementary immunization approach (MV + N). MV + N comprised seasonally administered maternal vaccination (MV; uptake 50%) with nirsevimab (N; uptake 70%) for unprotected infants (MV + N). Nirsevimab was administered seasonally with catch-up for infants born outside the RSV season. Analyses were conducted from the societal perspective and discounted 3% annually.</p> Results <p>Without immunization, 70,041 cases of RSV-LRTD (hospital: 23,273, ambulatory: 46,768) and 22 deaths were projected; total RSV-attributable medical care costs were 118.6&#xa0;million (M)&#xa0;€. With N-all, there were 39,247 cases (hospital 12,953; ambulatory 26,294) and 13 deaths; total associated costs were 311.5M&#xa0;€ (intervention 237.2M&#xa0;€; medical care 66.0M&#xa0;€; indirect 8.4M&#xa0;€). Compared to N-all, MV + N prevented an additional 666 cases and 1 death, with a difference in total costs of − 17.8M&#xa0;€ (intervention − 12.7M&#xa0;€; medical care − 4.7M&#xa0;€; indirect − 0.4M&#xa0;€). With 31 QALYs gained, MV + N was dominant versus N-All.</p> Conclusion <p>A complementary strategy with maternal RSVpreF vaccination and nirsevimab immunization for otherwise unprotected and preterm infants in Germany would provide a greater benefit compared to nirsevimab alone, protecting substantially more infants at lower total costs.</p>

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Cost-Effectiveness of Alternative Immunization Strategies to Protect Infants Against Respiratory Syncytial Virus in Germany: A Decision Modeling Study

  • Caroline Lade,
  • Erin Quinn,
  • Lea J. Bayer,
  • Amy W. Law,
  • Christof von Eiff,
  • Julia Schiffner-Rohe,
  • Mark Atwood,
  • Bennet Huebbe,
  • Ahuva Averin

摘要

Introduction

Germany’s Standing Committee on Vaccination (STIKO) recommends the use of monoclonal antibody nirsevimab for infants in their first respiratory syncytial virus (RSV) season; however, incorporating RSVpreF maternal vaccination may protect more infants while lowering healthcare costs. We therefore evaluated the cost-effectiveness of a complementary immunization approach comprising maternal RSVpreF vaccination during pregnancy and nirsevimab for infants not yet protected to prevent lower respiratory tract disease due to RSV (RSV-LRTD) among infants in Germany.

Methods

Clinical and economic outcomes of RSV-LRTD and the expected impact of interventions were modeled from birth to age < 1 year. Model inputs were based on German data as available. Intervention strategies included no intervention, nirsevimab alone (N-all; uptake 70%), and the complementary immunization approach (MV + N). MV + N comprised seasonally administered maternal vaccination (MV; uptake 50%) with nirsevimab (N; uptake 70%) for unprotected infants (MV + N). Nirsevimab was administered seasonally with catch-up for infants born outside the RSV season. Analyses were conducted from the societal perspective and discounted 3% annually.

Results

Without immunization, 70,041 cases of RSV-LRTD (hospital: 23,273, ambulatory: 46,768) and 22 deaths were projected; total RSV-attributable medical care costs were 118.6 million (M) €. With N-all, there were 39,247 cases (hospital 12,953; ambulatory 26,294) and 13 deaths; total associated costs were 311.5M € (intervention 237.2M €; medical care 66.0M €; indirect 8.4M €). Compared to N-all, MV + N prevented an additional 666 cases and 1 death, with a difference in total costs of − 17.8M € (intervention − 12.7M €; medical care − 4.7M €; indirect − 0.4M €). With 31 QALYs gained, MV + N was dominant versus N-All.

Conclusion

A complementary strategy with maternal RSVpreF vaccination and nirsevimab immunization for otherwise unprotected and preterm infants in Germany would provide a greater benefit compared to nirsevimab alone, protecting substantially more infants at lower total costs.