Nepal could achieve substantial health gains from the new WHO-recommended RSV prevention options for young infants, according to a modelling analysis in the Journal of Global Health. The study evaluates two passive immunisation strategies over 2025–2034: a maternal RSV vaccine (RSVpreF, Abrysvo) delivered during pregnancy and a long-acting monoclonal antibody for infants (nirsevimab, Beyfortus). Using the UNIVAC decision-support model and Nepal-specific inputs—including local cost-of-illness estimates and the latest trial efficacy data—the authors compare each product to the status quo (no RSV immunisation) and to each other, focusing on cost per disability-adjusted life year (DALY) averted from a government perspective.
Under base-case assumptions of US$5 per dose, the model suggests either approach could prevent more than 2,300 deaths and over 50,000 hospital admissions over ten years, with discounted programme costs of about US$30 million for maternal vaccination and US$35 million for the monoclonal antibody strategy. Estimated incremental cost-effectiveness was US$387 per DALY averted for maternal vaccination and US$486 per DALY averted for the monoclonal antibody, and the maternal vaccine dominated the antibody in the base case (more health benefit at lower cost). However, results were sensitive to key parameters—especially dose price, efficacy, duration of protection, and assumptions about RSV burden—and the cost-effectiveness of nirsevimab improved when administration was timely or when a seasonal delivery approach was modelled. Overall, the paper underscores a clear policy takeaway for immunization financing and planning in Nepal and similar settings: product choice will hinge on negotiated prices and feasible delivery strategies as RSV tools become available for broader LMIC introduction.
Thumbnail image credit: Shutterstock / Pratikjung
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