Potential public health and economic impact of maternal vaccination with bivalent respiratory syncytial virus prefusion F (RSVpreF) vaccine for the prevention of acute respiratory infection among infants in the United States

The U.S. Advisory Committee on Immunization Practices recommends use of bivalent stabilized prefusion F subunit vaccine (RSVpreF) among pregnant persons to protect their infants against lower respiratory tract illness due to RSV (RSV-LRTI).
Using a cohort model depicting clinical outcomes and economic costs of RSV acute respiratory infection (RSV-ARI) among US infants from birth to age 1 year, we evaluated the impact of seasonally administered maternal RSVpreF versus no intervention. Outcomes included cases of medically attended RSV-ARI, RSV-related deaths, medical costs, and indirect costs. Costs were reported in 2023 US$.
Among the 3.7 million US infants aged <12 months each year, a total of 1,148,967 RSV-ARI cases (hospital: 48,384; emergency department [ED]: 246,118; outpatient clinic [OC]: 854,465) were projected to occur, yielding total annual costs of $2.4 billion (direct: $1.7B; indirect: $0.7B). With 54.9% uptake, RSVpreF would prevent 89,908 cases (hospital: 10,308; ED: 20,538; OC: 59,062), corresponding with a $368 million decrease (direct: $286 M; indirect: $81 M) in total 1-year costs.
Even with limited uptake and without considering benefits to pregnant persons or reductions in RSV-related sequelae, maternal vaccination with RSVpreF would substantially reduce the public health and economic burden of RSV-ARI in US infants.