Journal article
Influential drivers of the cost-effectiveness of respiratory syncytial virus vaccination in European older adults: a multi-country analysis
- Abstract:
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Background
We aimed to identify influential drivers of the cost-effectiveness of older adult respiratory syncytial virus (RSV) vaccination in Denmark, Finland, the Netherlands and Valencia-Spain.
Methods
A static multi-cohort model was parameterised using country- and age-specific hospitalisations using three approaches: (A) the International Classification of Diseases (ICD)-coded hospitalisations, (B) laboratory RSV-confirmed hospitalisations and (C) time-series modelling (TSM). Plausible hypothetical RSV vaccine characteristics were derived from two protein subunit vaccines for adults aged ≥60 years. A full incremental analysis was conducted by comparing three RSV vaccination strategies: (1) in adults aged ≥60 years ("60y+"); (2) in adults aged ≥65 years ("65y+"); (3) in adults aged ≥75 years ("75y+") to "no intervention" and to each other. Both costs and quality-adjusted life-years (QALYs) were discounted at country-specific discount rates and the analysis was conducted from both the healthcare payers' and societal perspectives. Value of information, probabilistic sensitivity and scenario analyses identified influential drivers.
Results
Besides vaccine price, the hospitalisation estimates were most influential: (A) Using adjusted RSV-ICD-coded hospitalisations at a vaccine price of €150 per dose, no intervention was cost-effective up to willingness-to-pay (WTP) values of €150,000 per QALY gained in Denmark and the Netherlands, and up to €124,000 per QALY gained in Finland. (B) Using the adjusted RSV-confirmed dataset, the findings were consistent in Denmark and comparable in Finland. In Spain-Valencia, the 75y+ strategy became cost-effective at WTP >€55,000. (C) Using TSM-based estimates, the 75y+ strategy was cost-effective at WTP >€45,000, >€101,000, >€41,000 and >€114,000 in Denmark, Finland, the Netherlands and Spain-Valencia, respectively. Sensitivity analyses showed that the (in-hospital) case fatality ratio and the specification of its age dependency were both influential. Duration of protection was found more influential than a variety of plausible waning patterns over the duration of protection.
Conclusions
Data gaps and uncertainties on the RSV-related burden in older adults persist and influence the cost-effectiveness of RSV vaccination. More refined age- and country-specific data on the RSV attributable burden are crucial to aid decision making.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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- Files:
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(Preview, Supplementary materials, pdf, 2.0MB, Terms of use)
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(Preview, Version of record, pdf, 2.1MB, Terms of use)
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- Publisher copy:
- 10.1186/s12916-025-03970-x
Authors
Contributors
+ PROMISE investigators
- Role:
- Contributor
+ Pollard, AJ
- Institution:
- University of Oxford
- Division:
- MSD
- Department:
- Paediatrics
- Role:
- Contributor
- ORCID:
- 0000-0001-7361-719X
+ Innovative Medicines Initiative
More from this funder
- Funder identifier:
- https://ror.org/019af4n30
- Grant:
- 101034339
+ National Institute for Health Research
More from this funder
- Funder identifier:
- https://ror.org/0187kwz08
- Grant:
- NIHR200908
- NIHR200929
- Publisher:
- BioMed Central
- Journal:
- BMC Medicine More from this journal
- Volume:
- 23
- Issue:
- 1
- Article number:
- 170
- Place of publication:
- England
- Publication date:
- 2025-03-24
- Acceptance date:
- 2025-02-26
- DOI:
- EISSN:
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1741-7015
- Pmid:
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40128710
- Language:
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English
- Keywords:
- Pubs id:
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2101966
- Local pid:
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pubs:2101966
- Deposit date:
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2025-04-08
- ARK identifier:
Terms of use
- Copyright holder:
- Li et al.
- Copyright date:
- 2025
- Rights statement:
- © The Author(s) 2025. Open Access. This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.
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