Effectiveness and cost-effectiveness of RSV infant and maternal immunization programs: A case study of Nunavik, Canada

EClinicalMedicine

Affan Shoukat¹  Holden Sheffield²  Kevin Zhang³  Shokoofeh Nourbakhsh³  Seyed M. Moghadas⁴  Donna Halperin⁵  Joanne M. Langley⁶  Guillaume Poliquin⁷  Scott A. Halperin⁸ 

[1] Corresponding author.;Office of the Scientific Director, National Microbiology Laboratories, Public Health Agency of Canada, Winnipeg, Manitoba R3E 3R2, Canada;Agent-Based Modelling Laboratory, York University, Toronto, Ontario M3J 1P3, Canada;Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia B3K 6R8, Canada;Department of Medical Microbiology and Infectious Diseases, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba R3E 0J9, Canada;Department of Paediatrics, Qikiqtani General Hospital, Iqaluit, Nunavut X0A 0H0, Canada;Faculty of Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada;School of Nursing, St. Francis Xavier University, Antigonish, Nova Scotia B2G 2W5, Canada;

关键词: Respiratory syncytial virus;    Vaccines;    Long-acting monoclonal antibody;    Maternal vaccine;    Palivizumab;    Immunization programs;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: Despite passive immunization with palivizumab to select high-risk children under two years of age, the health and economic burden of respiratory syncytial virus (RSV) remains substantial. We evaluated the effectiveness and cost-effectiveness of immunization programs with new generations of RSV prophylactics, including long-acting monoclonal antibodies (LAMA) and maternal vaccines, in terms of reducing hospitalizations in Nunavik, a Canadian Arctic region. Methods: We developed an agent-based model of RSV transmission and parameterized it with the demographics and burden of RSV in Nunavik, Québec. We compared various immunization strategies, taking into account the costs associated with program delivery and calculating the incremental cost-effectiveness ratio (ICER) using quality-adjusted life-years (QALYs) gained as a measure of effectiveness. Scenario analyses included immunization with palivizumab and LAMA for infants under one year of age, and maternal vaccination in mild, moderate, and severe RSV seasons. Data were analysed from November 1, 2019 to May 1, 2021. Findings: We found that a Nunavik pilot program with palivizumab which included healthy full-term infants aged 0–2 months in addition to those considered high-risk for complicated RSV disease is not cost-effective, compared to offering palivizumab only to preterm/chronically ill infants under 1 year of age. Using LAMA as prophylaxis produces ICER values of CAD $39,414/QALY (95% Credible Interval [CrI]: $39,314–$40,017) in a mild season (moderately cost-effective) and CAD $5,255/QALY (95% CrI: $5,222–$5,307) in a moderate season (highly cost-effective). LAMA was a dominant (cost-saving with negative incremental costs and positive incremental effects) strategy in a severe RSV season. Maternal vaccination combined with immunization of preterm/chronically ill infants 3–11 months was also a dominant (cost-saving) strategy in all seasons. Interpretation: The switch from palivizumab in RSV immunization programs to new prophylactics would lead to significant savings, with LAMA being an effective strategy without compromising benefits in terms of reducing hospitalizations.

【 授权许可】

Unknown