Presentation (CTI)

OBJECTIVES: To model the province-level cost-effectiveness and value-based price (VBP) thresholds of maternal vaccination (MV) during pregnancy, and infant monoclonal antibody prophylaxis (nirsevimab, NIR) compared with the status quo (no intervention) in mainland China.
METHODS: We conducted a decision-analytic Markov model based on monthly cycles spanning the initial 6 months of infants' lives, evaluated by monthly birth cohorts, from a governmental perspective. We aggregated to province-specific target months dependent on RSV seasonality. Our analyses were stratified by 32 provinces/municipalities in China. We also assessed the cost-effectiveness in a high-risk subgroup scenario (higher disease incidence, mortality rate, and disease-related costs). We compare the incremental cost-effectiveness ratio to the province-level one-time three-times GDP per capita. Probabilistic sensitivity analysis (PSA) were also conducted.
RESULTS: The median MV value-based price (VBP) threshold at one time GDP per capita was approximately CNY 298 (range: CNY 140-909) for a province's local GDP per capita, and the median NIR VBP threshold versus no intervention was approximately CNY 404 (range: CNY 215-1215). In the subgroup scenario analysis of the high-risk group, NIR became more cost-effective at one time GDP per capita in 7 high-income provinces or municipalities (i.e., Beijing, Shanghai, Tianjin, Jiangsu, Zhejiang, Shenzhen, Guangzhou). One-way sensitivity analyses indicated that MV early hospitalization efficacy and incidence scaling were key drivers of MV VBP thresholds. PSA results were consistent with deterministic findings.
CONCLUSIONS: At a current price of over USD 400 or USD 500, universal MV or NIR programs are less likely to be cost-effective. To be cost-effective, policymakers and governments should set the price of universal MV and NIR at around CNY 298, or only target the high-risk infants in high-income jurisdictions.