Cost-Effectiveness of Bivalent Respiratory Syncytial Virus Prefusion F (RSVpreF) Maternal Vaccine for Protection of Infants in the United States (US)

OBJECTIVES: RSVpreF was recently recommended by the US Advisory Committee on Immunization Practices (ACIP) for seasonal administration among pregnant persons between 32-36 weeks of gestation to protect their infants against lower respiratory tract illness due to respiratory syncytial virus (RSV-LRTI). We evaluated the cost-effectiveness of the current recommendation for maternal vaccination as well as hypothetical recommendations including expanded seasonal and year-round vaccination.

METHODS: Cost-effectiveness of alternative vaccination scenarios (vs. no intervention [NI]) was evaluated using a cohort model depicting clinical outcomes and economic costs of RSV-LRTI from birth to age 1 year as well as the lifetime consequences of RSV-related death. Vaccination scenarios included the current seasonal recommendation (September-January), expanded seasonal recommendations (August-January; June-February; May-February), and a year-round recommendation; monthly uptake among qualifying pregnant persons was 54.9%. Clinical outcomes included RSV-LRTI cases (by care setting), RSV-related deaths, and quality-adjusted life-years (QALYs); economic costs included medical care for RSV-LRTI, vaccine-related adverse events, vaccination/administration, and caregiver work loss. Costs (2023 US$) and QALYs were discounted at 3%/year.

RESULTS: Seasonal maternal vaccination (September-January vs. NI) reduced RSV-LRTI cases by 88,327 (hospital: 10,126; ambulatory: 78,201) and total costs by $35 million, and thus was cost saving (i.e., dominant). Expanding the vaccination timeframe further reduced RSV-LRTI cases (vs. seasonal) by 20% for August-January, 49% for June-February, 55% for May-February, and 58% for year-round. Cost per QALY (vs. NI) ranged from cost saving (August-January) to $60,388 (May-February) for expanded seasonal vaccination and was $79,230 for year-round vaccination.

CONCLUSIONS: Under the current ACIP recommendation, use of RSVpreF maternal vaccine is projected to yield substantive reductions in RSV-LRTI cases and total economic costs among US infants. Expanding the seasonal recommendation would yield additional public health benefits and represent a favorable economic investment.