UNIVERSAL MATERNAL IMMUNIZATION AGAINST RESPIRATORY SYNCYTIAL VIRUS (RSV) IN BRAZIL: AN EXTENDED COST-EFFECTIVENESS ANALYSIS AT THE REGIONAL LEVEL
Author(s)
Sophia A M Borges, MD-PhD Candidate1, Patricia C. de Soarez, MPH, MSc, PhD2, Erick O. Polli, PhD2, Natacha Cerchiari, MSc, MD2, Ana Carolina Nonato, MSc, MD2, Marcia C. Castro, PhD3, Ana Marli C. Sartori, PhD2, Stéphane Verguet, PhD3.
1Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Harvard T.H. Chan School of Public Health, Boston, MA, USA, 2Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil, 3Harvard T.H. Chan School of Public Health, Boston, MA, USA.
1Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Harvard T.H. Chan School of Public Health, Boston, MA, USA, 2Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil, 3Harvard T.H. Chan School of Public Health, Boston, MA, USA.
OBJECTIVES: In Brazil, respiratory syncytial virus (RSV) is the primary cause of severe respiratory illness among young children. A maternal RSV vaccine (RSVpreF) has recently been introduced into the national immunization program. To our knowledge, no previous economic evaluation in Brazil has incorporated equity considerations. We applied extended cost-effectiveness analysis (ECEA) to evaluate the health benefits and costs of vaccination along with its distributional and financial risk protection (FRP) effects.
METHODS: We conducted an ECEA with a static cohort model following the 2023 Brazilian birth cohort (n=2,537,515) through their first year of life across 121 health macro-regions. The analysis compared universal maternal immunization (MI) with RSVPreF vs. no MI. Outcomes included RSV hospitalizations and deaths averted, disability-adjusted life years (DALYs) averted, out-of-pocket (OOP) expenditures, and catastrophic health expenditure (CHE) cases averted. Costs included vaccine procurement and delivery, healthcare costs, and household costs from a societal perspective. Incremental cost-effectiveness ratios (ICERs) were calculated as cost/DALY averted and compared against a threshold of 8,016 USD/DALY averted. Sensitivity analyses explored uncertainty in key parameters.
RESULTS: RSV MI was estimated to avert 84 infant deaths (24% of baseline) and 6,330 hospitalizations (19%) nationally. The program would avert around 1,900 CHE cases (10%) and reduce household OOP spending by around 320,000 USD (10%). Lower-income macro-regions would receive larger proportional gains across all outcomes. ICERs ranged from 6,240 to 410,000 USD/DALY averted (median: 35,810 USD/DALY averted). Only two macro-regions met the cost-effectiveness threshold. Vaccine price was the dominant cost driver: an 80% reduction would expand cost-effectiveness to 67 macro-regions out of 121.
CONCLUSIONS: MI was not cost-effective in most Brazilian macro-regions, yet yields distributional benefits. Price negotiation is required to achieve broader cost-effectiveness. This subnational ECEA reveals distributional heterogeneity masked by aggregate analyses and FRP benefits, offering a replicable equity-oriented framework for vaccine policy evaluation.
METHODS: We conducted an ECEA with a static cohort model following the 2023 Brazilian birth cohort (n=2,537,515) through their first year of life across 121 health macro-regions. The analysis compared universal maternal immunization (MI) with RSVPreF vs. no MI. Outcomes included RSV hospitalizations and deaths averted, disability-adjusted life years (DALYs) averted, out-of-pocket (OOP) expenditures, and catastrophic health expenditure (CHE) cases averted. Costs included vaccine procurement and delivery, healthcare costs, and household costs from a societal perspective. Incremental cost-effectiveness ratios (ICERs) were calculated as cost/DALY averted and compared against a threshold of 8,016 USD/DALY averted. Sensitivity analyses explored uncertainty in key parameters.
RESULTS: RSV MI was estimated to avert 84 infant deaths (24% of baseline) and 6,330 hospitalizations (19%) nationally. The program would avert around 1,900 CHE cases (10%) and reduce household OOP spending by around 320,000 USD (10%). Lower-income macro-regions would receive larger proportional gains across all outcomes. ICERs ranged from 6,240 to 410,000 USD/DALY averted (median: 35,810 USD/DALY averted). Only two macro-regions met the cost-effectiveness threshold. Vaccine price was the dominant cost driver: an 80% reduction would expand cost-effectiveness to 67 macro-regions out of 121.
CONCLUSIONS: MI was not cost-effective in most Brazilian macro-regions, yet yields distributional benefits. Price negotiation is required to achieve broader cost-effectiveness. This subnational ECEA reveals distributional heterogeneity masked by aggregate analyses and FRP benefits, offering a replicable equity-oriented framework for vaccine policy evaluation.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE449
Topic
Economic Evaluation, Epidemiology & Public Health, Health Policy & Regulatory
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Pediatrics, Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory), Vaccines