Cost-effectiveness of the adjuvanted RSVPreF3 vaccine among adults aged ≥60 years in the United States

Respiratory syncytial virus (RSV) is a common cause of acute respiratory illness in individuals of all ages, with adults aged ≥60 years and adults with certain chronic conditions at increased risk of severe RSV-related outcomes. This study evaluates the cost-effectiveness of the adjuvanted RSVPreF3 vaccine versus no vaccine in adults aged ≥60 years in the United States (US). A multi-cohort Markov model was developed with a 5-year time horizon and 1-month cycle length to compare outcomes for no vaccination and one-time adjuvanted RSVPreF3 vaccination (assuming the same vaccination as for influenza vaccines). Clinical parameters (e.g., vaccine efficacy) were based on phase 3 clinical trial data over 3 seasons, with all other inputs obtained from public US sources and scientific literature. Outcomes included total and incremental quality-adjusted life year (QALY) losses and costs, as well as incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were conducted to evaluate the sensitivity of results to inputs. In the base case, the model estimated that vaccinating 52.7 million adults aged ≥60 years with the adjuvanted RSVPreF3 vaccine once would result in 244,424 fewer QALY losses and an incremental societal cost of $4.5 billion over 5 years, with vaccination costs partially offset by reduced disease-related costs. From the societal perspective, adjuvanted RSVPreF3 vaccination resulted in an ICER of $18,430 per QALY gained. Results were relatively robust across sensitivity analyses and indicate that adjuvanted RSVPreF3 vaccination is a cost-effective option for the prevention of RSV in US adults aged ≥ 60 years, reducing the substantial burden within this population.

呼吸道合胞病毒（Respiratory syncytial virus, RSV）是引发各年龄段人群罹患急性呼吸道疾病的常见病原体，其中60岁及以上成人以及伴有特定慢性疾病的成人，发生严重RSV相关不良结局的风险显著升高。本研究评估了佐剂化RSVPreF3疫苗与不接种疫苗，针对美国（US）60岁及以上成人的成本效益。研究构建了时间跨度为5年、周期时长为1个月的多队列马尔可夫（Markov）模型，对比不接种疫苗与一次性接种佐剂化RSVPreF3疫苗（假设其接种方案与流感疫苗一致）的临床结局。临床参数（如疫苗效力）基于覆盖3个流行季的3期临床试验数据，其余所有输入参数均取自美国公开数据源与科学文献。研究结局包括总质量调整生命年（quality-adjusted life year, QALY）损失与总成本、增量质量调整生命年损失与增量成本，以及增量成本效益比（incremental cost-effectiveness ratios, ICERs）。本研究开展了敏感性分析，以评估研究结果对输入参数的敏感性。在基准场景中，模型估算显示，为5270万60岁及以上成人接种一剂佐剂化RSVPreF3疫苗，可在5年内减少244424个质量调整生命年损失，同时带来45亿美元的增量社会总成本，疫苗接种成本可因疾病相关成本的降低而得到部分抵消。从社会视角来看，佐剂化RSVPreF3疫苗接种的增量成本效益比为18430美元每获得1个质量调整生命年。敏感性分析结果显示该结论相对稳健，表明佐剂化RSVPreF3疫苗接种是美国60岁及以上成人预防RSV感染的具有成本效益的方案，可显著减轻该人群所承受的沉重疾病负担。