Li X, Hodgson D, Flaig J, Kieffer A, Herring WL, Beyhaghi H, Willem L, Jit M, Bilcke J, Beutels P, REspiratory Syncytial virus Consortium in EUrope (RESCEU) Investigators. Cost-effectiveness of respiratory syncytial virus preventive interventions in children: a model comparison study. Value Health. 2023 Apr;26(4):508-18. doi: 10.1016/j.jval.2022.11.014

OBJECTIVE: Model-based cost-effectiveness analysis on maternal vaccine (MV) and monoclonal antibody (mAb) interventions against respiratory syncytial virus (RSV) use context-specific data and produce varied results. Through model comparison, we aim to characterize RSV cost-effectiveness models and examine drivers for their outputs. 

METHODS: We compared three static and two dynamic models using a common input parameter set for a hypothetical birth cohort of 100,000 infants. Year-round and seasonal programmes were evaluated for MV and mAb interventions, using available evidence during the study period (e.g., phase 3 MV and phase 2b mAb efficacy).

RESULTS: Three static models estimated comparable medically-attended (MA) cases averted versus no intervention (MV: 1,019-1,073, mAb: 5,075-5,481), with the year-round MV directly saving ~€1 million medical and €0.3 million non-medical costs, while gaining 4-5 discounted Quality-adjusted life years (QALYs) annually in <1 year-olds, and mAb resulting in €4 million medical and €1.5 million non-medical cost savings, and 21-25 discounted QALYs gained. In contrast, both dynamic models estimated fewer MA cases averted (MV: 402-752, mAb: 3,362-4,622); one showed an age shift of RSV cases, whereas the other one reported many non-MA symptomatic cases averted, especially by MV (2014). These differences can be explained by model types, assumptions on non-MA burden and interventions' effectiveness over time.

CONCLUSIONS: Our static and dynamic models produced overall similar hospitalisation and death estimates, but also important differences, especially in non-MA cases averted. Despite the small QALY decrement per non-MA case, their larger number makes them influential for the costs per QALY gained of RSV interventions.