Cost-Benefit Analysis Favors RSV Vaccination for Older Adults
Investigators suggested that the future cost-effectiveness of respiratory syncytial virus (RSV) vaccination could be improved through lower vaccine prices and longer-lasting protection.
Vaccination against respiratory syncytial virus (RSV) in adults aged 60 years and older may be a cost-effective strategy to prevent illness, hospitalizations, deaths, and lost quality of life, according to new research published in Vaccine.1
Health care professional administering vaccine to older adult / Rido - stock.adobe.com
RSV poses health risks to older adults, leading to substantial morbidity and mortality, with the incidence of hospitalizations and the risk of severe outcomes increasing with age. What’s more, annual RSV-attributable health care costs associated with older adults are estimated to be $6.6 billion.2
In May 2023, the FDA approved GSK’s Arexvy and Pfizer’s Abrysvo for RSV. Although previous efforts to prevent and treat RSV have primarily focused on younger populations due to their high risk of severe outcomes, the Advisory Committee on Immunization Practices recognized the similar risks faced by older adults; in June 2023, it recommended that adults aged 60 and older receive a single dose of RSV vaccine.
On behalf of this recommendation, University of Michigan investigators and the CDC aimed to evaluate the cost-effectiveness of RSV vaccination for the more than 75 million adults aged 60 years and older in the US.1 They analyzed RSV-associated health care utilization within the patient population, including outpatient visits, emergency department visits, hospitalizations, and deaths.
The primary objectives were to estimate the number of RSV illnesses prevented by vaccination (assuming 2 seasons of protection) and to compare the cost-effectiveness of both GSK and Pfizer's vaccines to no vaccination older adults. Secondary objectives included assessing the cost-effectiveness in specific age subgroups and determining the number of vaccinations needed to avert particular outcomes.
Investigators developed a decision-analytical model to simulate the effects of a single-dose RSV vaccine on adults aged 60 and older. The model considered the long-term impact of the vaccine, including quality-adjusted life-years lost (QALYs) and societal costs due to RSV-related deaths. The analysis was conducted from a societal perspective and referenced the wholesale acquisition costs of $280 and $295 per GSK and Pfizer dose, respectively.
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Overall, researchers estimated that a 20% vaccination rate among adults aged 65 and older with either GSK or Pfizer’s vaccine would reduce outpatient RSV illnesses by 10.2% to 11.1% and hospitalizations and in-hospital deaths by 13.5% to 14.7%. They noted that an even higher vaccination rate could lead to greater reductions in RSV-related outcomes.
Additionally, while vaccination reduced some health care utilization, it also resulted in higher lifetime total societal costs for all age groups and vaccine costs evaluation. For example, vaccinating 20% of adults aged 65 and older with either GSK or Pfizer’s vaccine added between $3.4 and $3.6 billion in vaccination costs. Although this was partially offset by savings in other health care costs ($460 to $500 million) and productivity costs ($400 to $450 million), the net impact was an additional $2.5 to $2.6 billion in costs.
The societal cost per QALY saved from RSV vaccination depended on age group and product: for adults aged 60 years and older, this was $196,842 for GSK’s vaccine and $176,557 for Pfizer’s vaccine; for adults aged 65 years and older, this was $162,138 for GSK and $146,543 for Pfizer; and for adults aged between 60 and 65 years, this was $385,829 for GSK and $331,486 for Pfizer.
Although vaccine adverse events contributed to some QALYS, the overall benefit of vaccination was significant, saving approximately 15,700 to 18,000 QALYs in vaccinated adults aged 65 and older compared to no vaccination.
"We view this as a pivotal study that highlights the potential of RSV vaccination to make significant public health and economic impacts for older adults," said David Hutton, study author and professor of health management and policy and global public health at the University of Michigan's School of Public Health, in a news release.3 "As RSV continues to pose a serious threat to individuals in this age group, the goal is for these findings to provide timely insights for healthcare decision-makers and policymakers.
Based on study findings, investigators suggested that future cost-effectiveness of RSV vaccination could be improved through lower vaccine prices and longer-lasting protection. Additional research is needed to evaluate the vaccine’s long-term safety and effectiveness, particularly in different age groups and risk categories, including adults under 60.
“We look forward to continuing working with CDC to determine the best ways to use our health resources to prevent respiratory disease,” concluded Hutton.3
READ MORE: Immunization Resource Center
