Abstract
Background
Respiratory syncytial virus (RSV) is a leading cause of respiratory illness among infants, globally. Interventions currently available to prevent childhood RSV disease are limited; and the one currently available is costly even for high income countries. A few candidate interventions to protect against childhood RSV illness are in relatively advanced stages of development and could be available for global use in the near future. Here we evaluate the potential impact and cost-effectiveness a maternal RSV vaccine to help inform decision making around further development of such intervention and eventual use in low- and middle-income countries (LMICs).
Methods
We used a static population-based cohort model to evaluate impact and cost-effectiveness of RSV maternal vaccine across 133 low- and middle-income countries (LMICs), from a health systems perspective. Disease burden inputs as well as unit cost inputs were based on published literature. Intervention characteristics such as efficacy and duration of protection were derived from a recent phase 3 clinical trial for maternal vaccine (Pfizer). The intervention was evaluated at US$3 and $5 per dose for Gavi and non-Gavi countries, respectively. Country-specific co-financing for Gavi-eligible countries was not considered. A range of input values were considered to explore uncertainty.
Findings
This is an update to the previous model of impact and cost effectiveness using the more recent clinical trial data. Results using the updated vaccine efficacy and duration of protection data were consistent with previous estimates confirming the positive impact and cost effectiveness of RSV maternal vaccine across LMICs. The maternal vaccine was projected to be cost saving in 48 of the 133 LMICs, averting on average 30% of RSV related deaths among under 6 months old. The average incremental cost-effectiveness ratio (ICER) expressed in US$ per DALY averted was estimated to be cost $437 (across country range $7 to $1,045) under baseline assumptions.
Conclusions
Informed by the latest clinical trial on efficacy and duration of protection, the RSV maternal vaccine is projected to be impactful and cost effective across many LMICs. The final product characteristics and the product prices the governments will have to pay will influence this finding.