Cost of Childhood Rsv Management and Cost-Effectiveness of Rsv Interventions in Low- and Middle-Income Countries: A Systematic Review

OBJECTIVES: New RSV vaccines and mAbs in late-stage trials show promising clinical effectiveness, however evidence of economic value and affordability must also be considered if these interventions are to be accessible in LMICs where the burden is greatest. This systematic review’s objective was to summarise existing evidence on cost-of-illness and cost-effectiveness of RSV prevention interventions for children in LMICs.

METHODS: We conducted a systematic literature review using the Embase, MEDLINE, and Global Index Medicus databases for publications between Jan 2000 – Jan 2022 adhering to the PRISMA guidelines for conduct of systematic reviews. Of 491 articles reviewed, 19 met inclusion criteria. The outcome of interest for the COI studies was cost per episode and for CEA studies was incremental cost-effectiveness ratio. All costs were reported in 2020 USD$.

RESULTS: COI estimates varied widely: for severe RSV, cost per episode ranged from $92 to $4,114. Two COI studies considered household costs and found that the COI accounted for 24 – 37% of household monthly income. CEA results also varied: evaluations of long-acting mAbs found ICERs from $462/DALY averted to $2,971/DALY averted. Maternal immunization ICERs ranged from $1,440 - $8,753/DALY averted, and $19,307 - $118,845/QALY gained. Most of these estimates exceeded a WTP threshold of 1x the GDP per capita of the country. Among all included studies, assumptions of input parameters such as efficacy, cost, and duration of protection varied substantially.

CONCLUSIONS: RSV represents a substantial disease burden, however evidence regarding the economic burden is limited and inconsistent. Knowledge gaps remain regarding the economic value of new RSV prevention technologies specifically in LMICs. Further research is needed to understand the economic burden of childhood RSV in LMICs and reduce uncertainty about the relative value of anticipated RSV prevention interventions. Most CEA studies evaluated palivizumab with fewer analyses of interventions in development that may be more accessible for LMICs.