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Álvarez Aldean J, Rivero Calle I, Rodríguez Fernández R, Aceituno Mata S, Bellmunt A, Prades M, Law AW, López-Ibáñez de Aldecoa A, Méndez C, García Somoza ML, Soto J, Lozano V. Cost-effectiveness Analysis of Maternal Immunization with RSVpreF Vaccine for the Prevention of Respiratory Syncytial Virus Among Infants in Spain. Infect Dis Ther 2024; 13:1315-1331. [PMID: 38733493 PMCID: PMC11128416 DOI: 10.1007/s40121-024-00975-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/08/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infections (ALRI) in children under one year of age. In high-income countries, RSV infections cause a significant overload of care every winter, imposing a significant burden to the healthcare system, which has made the development of prevention strategies a major global health priority. In this context, a new bivalent RSV prefusion F protein-based vaccine (RSVpreF) has recently been approved. The objective of this study was to evaluate the cost-effectiveness of vaccinating pregnant women with the RSVpreF vaccine to prevent RSV in infants from the Spanish National Healthcare System (NHS) perspective. METHODS A hypothetical cohort framework and a Markov-type process were used to estimate clinical outcomes, costs, quality-adjusted life years (QALY) and cost-per-QALY gained (willingness-to-pay threshold: €25,000/QALY) for newborn infants born to RSV-vaccinated versus unvaccinated mothers over an RSV season. The base case analysis was performed from the NHS perspective including direct costs (€2023) and applying a discount of 3% to future costs and outcomes. To evaluate the robustness of the model, several scenarios, and deterministic and probabilistic analyses were carried out. All the parameters and assumptions were validated by a panel of experts. RESULTS The results of the study showed that year-round maternal vaccination program with 70% coverage is a dominant option compared to no intervention, resulting in direct cost savings of €1.8 million each year, with an increase of 551 QALYs. Maternal vaccination could prevent 38% of hospital admissions, 23% of emergency room visits, 19% of primary care visits, and 34% of deaths due to RSV. All scenario analyses showed consistent results, and according to the probabilistic sensitivity analysis (PSA), the probability of maternal vaccination being cost-effective versus no intervention was 99%. CONCLUSIONS From the Spanish NHS perspective, maternal vaccination with bivalent RSVpreF is a dominant alternative compared with a non-prevention strategy.
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Affiliation(s)
| | - Irene Rivero Calle
- Hospital Clínico Universitario de Santiago de Compostela, A Coruña, Spain
| | | | | | - Alba Bellmunt
- Market Access, Outcomes'10 S.L., Castellón de La Plana, Castellón, Spain.
| | - Miriam Prades
- Market Access, Outcomes'10 S.L., Castellón de La Plana, Castellón, Spain
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Lang JC, Kura K, Garba SM, Elbasha EH, Chen YH. Comparison of a static cohort model and dynamic transmission model for respiratory syncytial virus intervention programs for infants in England and Wales. Vaccine 2024; 42:1918-1927. [PMID: 38368224 DOI: 10.1016/j.vaccine.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND A recent study comparing results of multiple cost-effectiveness analyses (CEAs) in a hypothetical population found that monoclonal antibody (mAb) immunoprophylaxis for respiratory syncytial virus (RSV) in infants averted fewer medically attended cases when estimated using dynamic transmission models (DTMs) versus static cohort models (SCMs). We aimed to investigate whether model calibration or parameterization could be the primary driver of inconsistencies between SCM and DTM predictions. METHODS A recently published DTM evaluating the CEA of infant mAb immunoprophylaxis in England and Wales (EW) was selected as the reference model. We adapted our previously published SCM for US infants to EW by utilizing the same data sources used by the DTM. Both models parameterized mAb efficacy from a randomized clinical trial (RCT) that estimated an average efficacy of 74.5% against all medically attended RSV episodes and 62.1% against RSV hospitalizations. To align model assumptions, we modified the SCM to incorporate waning efficacy. Since the estimated indirect effects from the DTM were small (i.e., approximately 100-fold smaller in magnitude than direct effects), we hypothesized that alignment of model parameters should result in alignment of model predictions. Outputs for model comparison comprised averted hospitalizations and averted GP visits, estimated for seasonal (S) and seasonal-with-catchup (SC) immunization strategies. RESULTS When we aligned the SCM intervention parameters to DTM intervention parameters, significantly more averted hospitalizations were predicted by the SCM (S: 32.3%; SC: 51.3%) than the DTM (S: 17.8%; SC: 28.6%). The SCM most closely replicated the DTM results when the initial efficacy of the mAb intervention was 62.1%, leading to an average efficacy of 39.3%. Under this parameterization the SCM predicted 17.4% (S) and 27.7% (SC) averted hospitalizations. Results were similar for averted GP visits. CONCLUSIONS Parameterization of the RSV mAb intervention efficacy is a plausible primary driver of differences between SCM versus DTM model predictions.
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Affiliation(s)
- John C Lang
- Health Economic Decision Sciences, Biostatistics and Research Decision Sciences, Merck Canada Inc., Kirkland, QC, Canada
| | - Klodeta Kura
- Health Economic Decision Sciences, Biostatistics and Research Decision Sciences, MSD (UK) Limited, London, United Kingdom.
| | - Salisu M Garba
- Health Economic Decision Sciences, Biostatistics and Research Decision Sciences, Merck & Co., Inc., Rahway, NJ, USA
| | - Elamin H Elbasha
- Health Economic Decision Sciences, Biostatistics and Research Decision Sciences, Merck & Co., Inc., Rahway, NJ, USA
| | - Yao-Hsuan Chen
- Health Economic Decision Sciences, Biostatistics and Research Decision Sciences, MSD (UK) Limited, London, United Kingdom
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3
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Günther F, Sandmann FG. RSV immunisation in infants: weighing the options. THE LANCET REGIONAL HEALTH. EUROPE 2024; 38:100867. [PMID: 38476744 PMCID: PMC10928288 DOI: 10.1016/j.lanepe.2024.100867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 03/14/2024]
Affiliation(s)
- Felix Günther
- Immunisation Unit – Team Vaccine/VPD Modelling, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Frank G. Sandmann
- Immunisation Unit – Team Vaccine/VPD Modelling, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Uusitupa E, Waris M, Vuorinen T, Heikkinen T. Respiratory Syncytial Virus-Associated Hospitalizations in Children: A 10-Year Population-Based Analysis in Finland, 2008-2018. Influenza Other Respir Viruses 2024; 18:e13268. [PMID: 38477388 DOI: 10.1111/irv.13268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The risk of respiratory syncytial virus (RSV) hospitalization is highest during the first months of life, but few studies have assessed the population-based rates of hospitalization in monthly age groups of infants. METHODS We determined the average population-based rates of hospitalization with virologically confirmed RSV infections in children ≤15 years of age admitted during the 10-year period of 2008-2018. Testing for RSV was routine in all children hospitalized with respiratory infections, and all RSV-positive children admitted at any time during the study period were included in the analyses. RESULTS The annual population-based rate of RSV hospitalization was highest in infants 1 month of age (52.0 per 1000 children; 95% CI, 45.2-59.7), followed by infants <1 month of age (34.8 per 1000; 95% CI, 29.2-41.1) and those 2 months of age (32.2 per 1000; 95% CI, 26.9-38.4). In cumulative age groups, the rate of hospitalization was 39.7 per 1000 (95% CI, 36.2-43.4) among infants <3 months of age, 26.8 per 1000 (95% CI, 24.8-29.0) in infants aged <6 months, and 15.8 per 1000 (95% CI, 14.7-17.0) in those <12 months of age. CONCLUSION In monthly age groups of infants, the incidence rates of virologically confirmed RSV hospitalization in all infants up to 3 months of age were substantially higher than those reported in earlier studies. These data may be important for improving the estimates of the cost-effectiveness of various interventions to reduce the burden of RSV in young infants.
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Affiliation(s)
- Erika Uusitupa
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Matti Waris
- Department of Clinical Microbiology, Turku University Hospital, Turku, Finland
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Tytti Vuorinen
- Department of Clinical Microbiology, Turku University Hospital, Turku, Finland
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Terho Heikkinen
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
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Hak SF, Venekamp RP, Billard MN, van Houten MA, Pollard AJ, Heikkinen T, Cunningham S, Millar M, Martinón-Torres F, Dacosta-Urbieta A, Bont LJ, Wildenbeest JG. Substantial Burden of Nonmedically Attended RSV Infection in Healthy-Term Infants: An International Prospective Birth Cohort Study. J Infect Dis 2024; 229:S40-S50. [PMID: 38424744 DOI: 10.1093/infdis/jiad477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND During the first year of life, 1 in 4 infants develops a symptomatic respiratory syncytial virus (RSV) infection, yet only half seek medical attention. The current focus on medically attended RSV therefore underrepresents the true societal burden of RSV. We assessed the burden of nonmedically attended RSV infections and compared with medically attended RSV. METHODS We performed active RSV surveillance until the age of 1 year in a cohort (n = 993) nested within the Respiratory Syncytial Virus Consortium in EUrope (RESCEU) prospective birth cohort study enrolling healthy term-born infants in 5 European countries. Symptoms, medication use, wheezing, and impact on family life were analyzed. RESULTS For 97 of 120 (80.1%) nonmedically attended RSV episodes, sufficient data were available for analysis. In 50.5% (49/97), symptoms lasted ≥15 days. Parents reported impairment in usual daily activities in 59.8% (58/97) of episodes; worries, 75.3% (73/97); anxiety, 34.0% (33/97); and work absenteeism, 10.8% (10/93). Compared with medically attended RSV (n = 102, 9 hospital admissions), Respiratory Syncytial Virus NETwork (ReSViNET) severity scores were lower (3.5 vs 4.6, P < .001), whereas duration of respiratory symptoms and was comparable. CONCLUSIONS Even when medical attendance is not required, RSV infection poses a substantial burden to infants, families, and society. These findings are important for policy makers when considering the implementation of RSV immunization. Clinical Trials Registration. ClinicalTrials.gov (NCT03627572).
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Affiliation(s)
- Sarah F Hak
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht
| | - Roderick P Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University
| | - Marie-Noëlle Billard
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht
| | - Marlies A van Houten
- Department of Pediatrics, Spaarne Gasthuis, Hoofddorp and Haarlem, the Netherlands
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, United Kingdom
| | - Terho Heikkinen
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | | | - Margaret Millar
- Children's Clinical Research Facility, NHS Lothian, Edinburgh, United Kingdom
| | - Federico Martinón-Torres
- Genetics, Vaccines and Infections Research Group, Instituto de Investigación Sanitaria de Santiago, University of Santiago de Compostela, Spain
| | - Ana Dacosta-Urbieta
- Genetics, Vaccines and Infections Research Group, Instituto de Investigación Sanitaria de Santiago, University of Santiago de Compostela, Spain
| | - Louis J Bont
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht
| | - Joanne G Wildenbeest
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht
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Bollaerts K, Wyndham-Thomas C, Miller E, Izurieta HS, Black S, Andrews N, Rubbrecht M, Van Heuverswyn F, Neels P. The role of real-world evidence for regulatory and public health decision-making for Accelerated Vaccine Deployment- a meeting report. Biologicals 2024; 85:101750. [PMID: 38360428 DOI: 10.1016/j.biologicals.2024.101750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 02/04/2024] [Indexed: 02/17/2024] Open
Abstract
The COVID-19 pandemic underscored the need for rapid evidence generation to inform public health decisions beyond the limitations of conventional clinical trials. This report summarises presentations and discussions from a conference on the role of Real-World Evidence (RWE) in expediting vaccine deployment. Attended by regulatory bodies, public health entities, and industry experts, the gathering was a collaborative exchange of experiences and recommendations for leveraging RWE for vaccine deployment. RWE proved instrumental in refining decision-making processes to optimise dosing regimens, enhance guidance on target populations, and steer vaccination strategies against emerging variants. Participants felt that RWE was successfully integrated into lifecycle management, encompassing boosters and safety considerations. However, challenges emerged, prompting a call for improvements in data quality, standardisation, and availability, acknowledging the variability and potential inaccuracies in data across diverse healthcare systems. Regulatory transparency should also be prioritised to foster public trust, and improved collaborations with governments are needed to streamline data collection and navigate data privacy regulations. Moreover, building and sustaining resources, expertise, and infrastructure in LMICs emerged as imperative for RWE-generating capabilities. Continued stakeholder collaboration and securing adequate funding emerged as vital pillars for advancing the use of RWE in shaping responsive and effective public health strategies.
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Affiliation(s)
| | | | - Elizabeth Miller
- London School of Hygiene and Tropical Medicine (LSHTM), United Kingdom
| | | | - Steve Black
- Global Vaccine Data Network (GVDN), New Zealand
| | - Nick Andrews
- UK Health Security Agency (UKHSA), United Kingdom
| | | | | | - Pieter Neels
- International Alliance of Biological Standardization (IABS-EU), Belgium.
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Broberg EK, Nohynek H. Respiratory syncytial virus infections - recent developments providing promising new tools for disease prevention. Euro Surveill 2023; 28:2300686. [PMID: 38062943 PMCID: PMC10831406 DOI: 10.2807/1560-7917.es.2023.28.49.2300686] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 12/18/2023] Open
Affiliation(s)
- Eeva K Broberg
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Hanna Nohynek
- Finnish institute for health and welfare, Helsinki, Finland
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Francisco L, Cruz-Cañete M, Pérez C, Couceiro JA, Otheo E, Launes C, Rodrigo C, Jiménez AB, Llorente M, Montesdeoca A, Rumbao J, Calvo C, Frago S, Tagarro A. Nirsevimab for the prevention of respiratory syncytial virus disease in children. Statement of the Spanish Society of Paediatric Infectious Disease (SEIP). An Pediatr (Barc) 2023; 99:257-263. [PMID: 37743207 DOI: 10.1016/j.anpede.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023] Open
Abstract
INTRODUCTION Nirsevimab, a monoclonal antibody for the prevention of disease caused by respiratory syncytial virus (RSV), has recently been approved for use in Europe and Spain. OBJECTIVES To provide recommendations for the administration of nirsevimab for prevention of RSV disease. METHODS The approach chosen to develop these recommendations involved a critical review of the literature and the use of the Delphi and GRADE methods. An expert group was formed. The group engaged in three rounds to define the questions, express support or opposition, grade recommendations and establish the agreement or disagreement with the conclusions. RESULTS In the general neonatal population, routine administration of nirsevimab is recommended to reduce the frequency of illness and hospitalisation for bronchiolitis and RSV lower respiratory tract infection. Nirsevimab is recommended for all infants born in high-incidence RSV season and infants aged less than 6 months at the season onset. In infants born preterm between 29 and 35 weeks of gestation, with haemodynamically significant heart disease or with chronic lung disease, routine administration of nirsevimab is recommended to reduce the incidence of disease and hospitalisation due to bronchiolitis and RSV lower respiratory tract infection. In patients in whom palivizumab is currently indicated, its substitution by nirsevimab is recommended to reduce the burden of bronchiolitis. CONCLUSIONS Routine administration of nirsevimab to all infants aged less than 6 months born during the RSV season or aged less than 6 months at the start of the winter season is recommended to reduce the burden of disease and the frequency of hospitalization due to bronchiolitis.
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Affiliation(s)
- Laura Francisco
- Centro de Salud San Fermin, Gerencia Asistencial de Atención Primaria, Dirección Asistencial Centro, Madrid, Grupo de Trabajo de Infecciones Respiratorias de la Sociedad Española de Infectología Pediátrica, Spain
| | - Marta Cruz-Cañete
- Servicio de Pediatría, Hospital de Montilla, Grupo de Trabajo de Infecciones Respiratorias de la Sociedad Española de Infectología Pediátrica, Spain
| | - Carlos Pérez
- Servicio de Pediatría, Hospital Universitario de Cabueñes, Gijón, Grupo de Trabajo de Infecciones Respiratorias de la Sociedad Española de Infectología Pediátrica, Spain
| | - José Antonio Couceiro
- Servicio de Pediatría, Complejo Hospitalario de Pontevedra, Grupo de Trabajo de Infecciones Respiratorias de la Sociedad Española de Infectología Pediátrica, Spain
| | - Enrique Otheo
- Servicio de Pediatría, Hospital Universitario Ramón y Cajal, Madrid, Universidad de Alcalá. Grupo de Trabajo de Infecciones Respiratorias de la Sociedad Española de Infectología Pediátrica, Spain
| | - Cristian Launes
- Servicio de Pediatría, Hospital Sant Joan de Déu (HSJD), Barcelona, Spain, Universidad de Barcelona, Barcelona, Spain, Grupo de Investigación en Enfermedades Infecciosas Pediátricas, Institut de Recerca Sant Joan de Déu, Barcelona, Spain, CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España. Departamento de Cirugía y Especialidades Médico-Quirúrgicas, Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, Barcelona, Spain, Grupo de Trabajo de Infecciones Respiratorias de la Sociedad Española de Infectología Pediátrica, Spain
| | - Carlos Rodrigo
- Servicio de Pediatría, Hospital Universitari Germans Trias i Pujol, Barcelona, Facultad de Medicina-Unidad Docente Germans Trias i Pujol, Universidad Autónoma de Barcelona, Grupo de Trabajo de Infecciones Respiratorias de la Sociedad Española de Infectología Pediátrica, Spain
| | - Ana Belén Jiménez
- Servicio de Pediatría, Fundación Jiménez Díaz, Madrid, Grupo de Trabajo de Infecciones Respiratorias de la Sociedad Española de Infectología Pediátrica, Spain
| | - Marta Llorente
- Servicio de Pediatría, Hospital de Arganda, Madrid, Grupo de Trabajo de Infecciones Respiratorias de la Sociedad Española de Infectología Pediátrica, Spain
| | - Abián Montesdeoca
- Atención Primaria, Centro de Salud de Guanarteme, Las Palmas de Gran Canaria, Miembro del CAV-AEP, Spain
| | - José Rumbao
- Servicio de Pediatría, Hospital Reina Sofía, Córdoba, Spain
| | - Cristina Calvo
- Servicio de Pediatría, Enfermedades Infecciosas y Tropicales Pediátricas, Hospital Universitario la Paz, Fundación IdiPaz, CIBERINFEC ISCIII, Madrid, Spain, Universidad Autónoma de Madrid, Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Grupo de Trabajo de Infecciones Respiratorias de la Sociedad Española de Infectología Pediátrica, Spain
| | - Susana Frago
- Representante de Familias de Pacientes, Miembro de la Asociación de Padres de Niños Prematuros (APREM), Spain
| | - Alfredo Tagarro
- Servicio de Pediatría, Hospital Universitario Infanta Sofía, Fundación Para la Investigación Biomédica e Innovación Hospital Universitario Infanta Sofía y Hospital del Henares (FIIB HUIS HHEN). Instituto de Investigación 12 de Octubre (imas12), Madrid, Universidad Europea de Madrid, Grupo de Trabajo de Infecciones Respiratorias de la Sociedad Española de Infectología Pediátrica, Spain.
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Kieffer A, Beuvelet M, Sardesai A, Musci R, Milev S, Lee JKH. Response to Fullarton et al. J Infect Dis 2023; 227:1335-1336. [PMID: 36519404 PMCID: PMC10226654 DOI: 10.1093/infdis/jiac489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 01/06/2024] Open
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