Nirsevimab for RSV Prevention in Hong Kong Infants: A Cost-Effectiveness Analysis
Author(s)
YINGCHENG WANG, MSc, Mingjun Rui, MSc, Joyce You, PharmD;
The Chinese University of Hong Kong, School of Pharmacy, Faculty of Medicine, Hong Kong, China
The Chinese University of Hong Kong, School of Pharmacy, Faculty of Medicine, Hong Kong, China
OBJECTIVES: Respiratory Syncytial Virus (RSV) is a leading cause of lower respiratory tract infections (LRTI) in infants. Nirsevimab, a long-acting monoclonal antibody, provides broad protection and demonstrates high efficacy. This study evaluated the cost-effectiveness of various nirsevimab immunization strategies from the Hong Kong societal perspective.
METHODS: A Markov model with monthly cycle was developed to simulate the one-year outcomes of the 2024 birth cohort in Hong Kong (36,106 newborns). Four immunization strategies were evaluated in the model: (1) No intervention; (2) single-dose of nirsevimab at birth throughout the year (year- round); (3) single-dose nirsevimab at birth for infants born during the RSV season and at the start of the season for those born outside season (catch-up); (4) single-dose of nirsevimab to infants born during RSV season (seasonal). Model inputs were retrieved from public data and literature. Primary outcomes included RSV-LRTI related events, direct and indirect costs, quality-adjusted life year (QALY) loss, and incremental cost per QALY gained (ICER).
RESULTS: All nirsevimab immunization strategies reduced RSV-LRTI infections, hospitalizations, ICU admissions and deaths. The QALY loss in the catch-up strategy was the lowest (9.94), followed by year-round (11.11), seasonal (16.02), and no intervention (22.15). When compared with no intervention, ICERs for all nirsevimab strategies exceeded the willingness-to-pay (WTP) threshold (50,723 USD/QALY). The year-round and seasonal strategies had higher costs and QALY loss than catch-up strategy and were therefore dominated. No influential factors were identified in one-way sensitivity analysis. The extended one-way sensitivity analysis of the nirsevimab price indicated that catch-up strategy would be cost-effective (versus no intervention) when the drug cost was USD 105 or less at a WTP threshold of 50,723 USD/QALY.
CONCLUSIONS: The catch-up strategy for nirsevimab administration appears to be effective, and its cost-effectiveness in Hong Kong is highly subject to the drug cost.
METHODS: A Markov model with monthly cycle was developed to simulate the one-year outcomes of the 2024 birth cohort in Hong Kong (36,106 newborns). Four immunization strategies were evaluated in the model: (1) No intervention; (2) single-dose of nirsevimab at birth throughout the year (year- round); (3) single-dose nirsevimab at birth for infants born during the RSV season and at the start of the season for those born outside season (catch-up); (4) single-dose of nirsevimab to infants born during RSV season (seasonal). Model inputs were retrieved from public data and literature. Primary outcomes included RSV-LRTI related events, direct and indirect costs, quality-adjusted life year (QALY) loss, and incremental cost per QALY gained (ICER).
RESULTS: All nirsevimab immunization strategies reduced RSV-LRTI infections, hospitalizations, ICU admissions and deaths. The QALY loss in the catch-up strategy was the lowest (9.94), followed by year-round (11.11), seasonal (16.02), and no intervention (22.15). When compared with no intervention, ICERs for all nirsevimab strategies exceeded the willingness-to-pay (WTP) threshold (50,723 USD/QALY). The year-round and seasonal strategies had higher costs and QALY loss than catch-up strategy and were therefore dominated. No influential factors were identified in one-way sensitivity analysis. The extended one-way sensitivity analysis of the nirsevimab price indicated that catch-up strategy would be cost-effective (versus no intervention) when the drug cost was USD 105 or less at a WTP threshold of 50,723 USD/QALY.
CONCLUSIONS: The catch-up strategy for nirsevimab administration appears to be effective, and its cost-effectiveness in Hong Kong is highly subject to the drug cost.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE210
Topic
Economic Evaluation
Disease
SDC: Infectious Disease (non-vaccine), SDC: Pediatrics, SDC: Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)