Document text
Economics of Respiratory Syncytial Virus
Vaccination in Adults aged 50 -59 years
at Increased Risk of Severe RSV Disease
SUMMARY COMPARING MODELS FROM:
GSK,Moderna ,Pfizer AND University of Michigan -CDC
Ismael R. Ortega -Sanchez, PhD
NCIRD/CDC
ACIP Meeting, April 16, 2025
1Disclaimer : The findings and conclusions in this report are those of the authors and do not necessarily represent the views of
the Centers for Disease Control and Prevention.
Conflicts of interest
•GSK model : David Singer et al., [complete list and affiliations, upon request]
•GSK manufactures the adjuvanted RSVPreF3 (RSVPreF3) vaccine
•RTI Health Solutions was funded by GSK
•Moderna model : Parinaz Ghaswalla et al., [complete list and affiliations, upon request]
•Moderna manufacturers the mRNA -1345 RSV vaccine
•Quadrant Health Economics and RTI Health Solutions were funded by Moderna
•Pfizer model : Reiko Sato et al., [complete list and affiliations, upon request]
•Pfizer Inc (PA, USA) manufacturers the bivalent stabilized prefusion F subunit ( RSVpreF ) vaccine
•Avalere Health (Washington DC, USA) was funded by Pfizer
•UM-CDC model : David W Hutton et al. from Univ Michigan, …, Ismael R Ortega -Sanchez et al. from CDC
[complete list and affiliations, upon request ]
•All authors: No conflicts of interest
2
Economic analysis
Policy question : Should a single dose of RSV vaccine (any licensed product)a,b be
recommended for adults 50 -59 years old at increased risk of severe RSV disease?
Cost -effectiveness analyses :
Comparator Intervention
Base -case scenario:
•What is the incremental cost-effectiveness of vaccinating adults aged 50 -59 years
at increased risk of severe RSV disease relative to no vaccination?
3No vaccinationVaccination:
Receipt of one dose of any
licensed RSV vaccine
a. GSK and Pfizer vaccines are currently licensed for adults 50 -59 years at increased risk: https://www.fda.gov/vaccines -blood -
biologics/arexvy , https://www.fda.gov/vaccines -blood -biologics/abrysvo
b. Moderna vaccine is not currently licensed in adults aged <60 years: https://www.fda.gov/vaccines -blood -biologics/vaccines/mresvia
4Modeling design and assumptions
GSK Moderna Pfizer UM-CDC
Static analytical decision -making models
Sensitivity analyses (and probabilistic simulation)
(
)
(
)
(
)
(
)
Hypothetical population: 50 -59 years old at increased risk
Timeframe after a dose of RSV vaccine (in years)a 5 3 3.5b 3 and 2c
Analytic Horizon: Age - and comorbidity -specific life expectancy
Age only
Discount rate: 3%
Year of economic outcomes measured 2024 2024 2023 2024
Societal perspective (and healthcare perspective)
(
)
(
)
(
)
(
)
a.Base -case in Moderna, and Pfizer models relied on a three -year timeframe (other timeframes included in scenario analyses) while GSK used a five -year timeframe in the base -case and
three -year in scenario. In each model, selection of timeframe is based on the duration of protection assumption.
b.Although Pfizer base -case relies on a thee -year timeframe, in scenario analyses Pfizer reported outcomes for up to 70 months (>5 years timeframe) duration of vaccine protection.
c.Base -case in UM -CDC model uses three -year time frame for protein subunit vaccines and a two -year time frame for mRNA vaccine. However, in a scenario analysis UM -CDC model
uses a three -year time frame for the mRNA vaccine
GSK, Moderna , Pfizer and UM-CDC models
comparison
We will compare:
•Risk conditions included in base -case and scenarios
•Incidence of RSV hospitalization and outpatient care
•Medical costs due to RSV illness
•RSV mortality rate
•Indirect costs due to RSV illness
•Quality -adjusted life years lost per RSV illness
•Initial vaccine effectiveness and waning assumptions
51st
2nd
3rd
4th
GSK, Moderna , Pfizer and UM-CDC models comparison:
Risk conditions included in base -case and scenarios
6GSK Moderna Pfizer UM-CDC
Base -caseChronic obstructive
pulmonary disease
(COPD)≥ 1 chronic medical
conditiona≥ 1 chronic or
immunocompromising
medical conditionb≥ 1 chronic medical
conditionc
Individual
conditions
evaluated in
scenarios•Asthma
•Congestive heart failure
•Coronary artery disease
•Diabetes mellitus•Asthma
•COPD
•Coronary artery disease
•Congestive heart failure
•Chronic kidney disease
•Chronic liver disease
•Diabetes mellitus
•Severe obesity (body
mass index [BMI] ≥40
kg/m2)•Cardiovascular disease
•Pulmonary disease
•Renal disease
•Diabetes mellitus
•Immunocompromising
conditions (e.g., solid cancer,
hematological malignancies,
solid organ transplant, or
receiving immunosuppressive
medication)•Asthma
•COPD
•Coronary artery disease
•Chronic kidney disease
•Diabetes mellitus
•Severe obesity (BMI ≥40
kg/m2)
•Heart failure
•Lung transplant
•Allogeneic hematopoietic
cell transplant
•Autologous hematopoietic
cell transplant
a.Moderna model: “≥ 1 chronic medical condition” included asthma, COPD, coronary artery disease, congestive heart failure, chro nic kidney disease, chronic liver disease, diabetes mellitus, ,
and severe obesity.
b.Pfizer model: “≥ 1 chronic or immunocompromising medical condition” included cardiovascular disease, hematologic disease, hep atic disease, metabolic disorders, pulmonary disease, renal
disease, severe obesity (BMI ≥40 kg/m2), and immunocompromising conditions.
c.University of Michigan -CDC model: “≥ 1 chronic medical condition” included asthma, COPD, coronary artery disease, chronic kidney disease, diabetes mellitus, and severe obesity (BMI ≥40
kg/m2).
7UM-CDC GSK
Incidence of RSV outpatient illness
(per 100,000 persons per year)2,940 for adults 50 -59 years with cardiopulmonary
disease (e.g., COPD) a
1,722 for adults 50 -59 years with other chronic
condition (e.g., diabetes mellitus) a2,926
for adults 50 -59 years with COPD a
Incidence of RSV hospitalization
(per 100,000 persons per year)106 for adults 50 -59 years with ≥1 chronic
condition b
169 for adults 50 -59 years with COPD, specifically b311
for adults 50 -59 years with COPD c
Medical costs per RSV hospitalization
$40,439 ($32,352 –$48,527)d $30,774
(range +/ - 20% )e
Medical costs per RSV ED visit and
per RSV Outpatient visit$5,235 ($4,188 –$6,282)d
$586 ($469 –$704)d$884 (range +/ - 20%)f
$256 (range +/ - 20%)f
a.Adapted from Belongia et al. Open Forum Infect Dis (2022). https://pubmed.ncbi.nlm.nih.gov/30619907/ . Adjusted upward by a factor of 1.5 for diagnostic test sensitivity in detecting RSV
infection (McLaughlin et al. [2022]) https://pubmed.ncbi.nlm.nih.gov/35873302/
b.CDC unpublished data, updates to analysis presented to ACIP (Woodruff, February 2024: https://www.cdc.gov/acip/downloads/slides -2024 -02-28-29/03 -RSV-Adults -Woodruff -508.pdf ).
c.Adapted from Branche et al. (2022), https://pubmed.ncbi.nlm.nih.gov/34244735/ across Rochester and New York City sites adjusted by a factor of 1.5 for diagnostic test sensitivity in
detecting RSV infection (McLaughlin et al. [2022]) https://pubmed.ncbi.nlm.nih.gov/35873302/
d.For the general population, adjusted according to results for adults with and without chronic conditions. Averin et al. (2024) https://pubmed.ncbi.nlm.nih.gov/38486815/
e.CMS Medicare Inpatient Hospitals - by Geography and Service (CMS, 202 4); (DRG Average Payments from 2022 dataset); Falsey et al. (2005) https://pubmed.ncbi.nlm.nih.gov/15858184/
f.CMS.gov Hospital Outpatient Prospective Payment (CMS, 2024). Average of CPT 99283 and 99284. Added is the physician fee from CMS.gov Physician Fee Lookup Tool (CMS, 2024). Average
of CPT 99283 and 99284. https://www.cms.gov/medicare/payment/prospective -payment -systems/hospital -outpatient/regulations -notices/cms -1786 -fc UM-CDC and GSK models: Incidence and medical
costs of RSV hospitalization and outpatient care
8UM-CDC Moderna
Incidence of RSV outpatient illness
(per 100,000 persons per year) 1,722 for adults 50 -59 years with ≥1 chronic
conditiona2,322 for adults 50 -59 years with ≥1
conditions and
964 for adults 50 -59 years,
without chronic conditionsb
Incidence of RSV hospitalization
(per 100,000 persons per year)106 for adults 50 -59 years with ≥ 1 chronic
condition c 217.9 for adults 50 -59 years with ≥1
conditions b
Medical costs per RSV hospitalization$40,439
($32,352 – $48,527) e $11,876
($8,407 - $47,512)f
Medical costs per RSV ED visit and
per RSV Outpatient visit$5,235 ($4,188 – $6,282) e
$586 ($469 – $704) e$4,399 ( no range ) d, g
$2,273 ( no range ) f
a. Adapted from Belongia et al. Open Forum Infect Dis (2022). https://pubmed.ncbi.nlm.nih.gov/30619907/ . Adjusted upward by a factor of 1.5 for diagnostic test sensitivity in detecting RSV infection
(McLaughlin et al. [2022]) https://pubmed.ncbi.nlm.nih.gov/35873302/
b. Adjusted by 1.5x for PCR test sensitivity. Adapted from McLaughlin et al. Open Forum Infect Dis (2022), https://pubmed.ncbi.nlm.nih.gov/30619907/ and Weycker (2024),
https://pubmed.ncbi.nlm.nih.gov/38236516/ using methods applied in Averin (2024), https://pubmed.ncbi.nlm.nih.gov/38486815/
c. CDC unpublished data, updates to analysis presented to ACIP (Woodruff, February 2024: https://www.cdc.gov/acip/downloads/slides -2024 -02-28-29/03 -RSV-Adults -Woodruff -508.pdf ).
d. Averin et al. (2024) Supplemental Table 3 https://pubmed.ncbi.nlm.nih.gov/38486815/
e. For the general population, adjusted according to results for adults with and without chronic conditions. Averin et al. (2024) https://pubmed.ncbi.nlm.nih.gov/38486815/
f. Wyffels et al. (2020), https://pubmed.ncbi.nlm.nih.gov/32026380/ (Moderna’s technical report provides inpatient cost ranges based on assumptions and supported by other studies)
g. Merative MarketScan Commercial Claims and Encounters (CCAE) and Medicare Supplemental Coordination of Benefits (MDCR) Databases (2016 -2019)UM-CDC and Moderna models: Incidence and
medical costs of RSV hospitalization and outpatient care
9UM-CDC Pfizer
Incidence of RSV outpatient illness
(per 100,000 persons per year)1,722 for adults 50 -59 years with ≥1 chronic
medical condition (e.g., diabetes mellitus) a3,158
for adults 50 -59 years with ≥1 condition b
Incidence of RSV hospitalization
(per 100,000 persons per year)106 for adults 50 -59 years with ≥ 1 chronic
condition c 367
for adults 50 -59 years with ≥1 condition b
Medical costs per RSV hospitalization$40,439
($32,352 – $48,527) d $40,361
(no range reported)e
Medical costs per RSV ED visit and
per RSV Outpatient visit$5,235 ($4,188 – $6,282) d
$586 ($469 – $704) d$6,168 ( no range reported ) d, e
$933 ( no range reported ) d, e
a.Adapted from Belongia et al. Open Forum Infect Dis (2022). https://pubmed.ncbi.nlm.nih.gov/30619907/ . Adjusted upward by a factor of 1.5 for diagnostic test sensitivity in detecting RSV
infection (McLaughlin et al. [2022]) https://pubmed.ncbi.nlm.nih.gov/35873302/
b.Adapted from McLaughlin et al. (2022), https://pubmed.ncbi.nlm.nih.gov/35873302/ ; Weycker et al. (2024), https://pubmed.ncbi.nlm.nih.gov/38236516/ ; Ramirez et al. (2023),
https://pubmed.ncbi.nlm.nih.gov/37148463/ ; Onwuchekwa et al. (2023), https://pubmed.ncbi.nlm.nih.gov/36661222/ . Age and risk group is 50 -64 years with selected chronic or
immunocompromising medical conditions.
c.CDC unpublished data, updates to analysis presented to ACIP (Woodruff, February 2024: https://www.cdc.gov/acip/downloads/slides -2024 -02-28-29/03 -RSV-Adults -Woodruff -508.pdf ).
d.For the general population, adjusted according to results for adults with and without chronic conditions. Averin et al. (2024) https://pubmed.ncbi.nlm.nih.gov/38486815/
e.Averin et al (2024) , https://doi.org/10.1093/ofid/ofae097 .UM-CDC and Pfizer models: Incidence and
medical costs of RSV hospitalization and outpatient care
GSK, Moderna , Pfizer and UM-CDC models:
Mortality, indirect costs and quality -adjusted life -years
10GSK Moderna Pfizer UM-CDC
Mortality
(case fatality
ratio, CFR)7.0% CFR among COPD
hospitalized for RSV -LRTD4.3% CFR among hospitalized 4.7% CFR among hospitalized
50-64y CMC+6.4 deaths per 100 RSV
hospitalizations, inclusive of
deaths among non -
hospitalized persons
Indirect costs
(productivity
losses)Premature death
Market:
50-54 years: $871,542
55-59 years: $601,091
Nonmarket:
50-54 years: $691,270
55-59 years: $621,604
Days of work lost
Inpatient care: 15.18
ED/Outpatient care: 4.30
No treatment: 0.50Premature death
Not included in their analyses
Days of work lost
Inpatient care: 7.53
ED care: 3.30
Outpatient care: 2.30
Presenteeism: 1 day all cases
Caregiver: 0.75x patient’s timePremature death
50-59 years with CMC+:
$333,915
Days of work lost
Inpatient care: 10
ED/Outpatient care: 5
Caregiver: 0.50x patient’s timePremature death
Age-specific annual mortality
and life expectancy from life
tablesa multiplied by market
and non -market foregone
income and discounted at 3%
per year
Days of work lost
Inpatient care: 8
ED/Outpatient care: 2.50
QALY LossRSV-URTD 0.0133
RSV-LRTD 0.0178 ED/Outpatient 0.0185
Inpatient 0.0193
No treatment 0.0093ED/Outpatient 0.0054
Inpatient 0.0167Outpatient 0.0185
Inpatient 0.0193
a. Vital Statistics Reports. National Vital Statistics Reports Vol 71, No 1, August 8, 2022. United States Life Tables, 2020. Pu b. online 2022. Accessed March 7, 2025. https://www.cdc.gov/nchs/products/index.htm
Abbreviations : COPD= chronic obstructive pulmonary disease, LRTD= lower respiratory tract disease, CFR= case fatality ratio, ED= Emergency d epartment, CMC+= selected chronic or immunocompromising
medical conditions, QALY= quality -adjusted life -year
42 48 54 60
GSK (RSVPreF3) and UM-CDC (subunit): Modeled vaccine
effectiveness and duration of protection per outcome
11
The pink -shaded area denotes a higher level of uncertainty of the waning assumption
a. Three -year projected effectiveness against ED and hospitalization based on a meta -analysis of real -world vaccine effectiveness s tudies. Base case truncated at 36
months based on available clinical follow -up extending only through three RSV seasons for a subunit vaccineGSKSource : La EM, et al..
Hum Vaccin
Immunother . 2024
Dec
31;20(1):2432745.
https://doi.org/10.1
080/21645515.2024.
2432745
LRTD= Lower
respiratory tract
disease, ARI = acute
respiratory infectionSource : UM -CDC
is based on
Hutton et al.
ACIP
presentation
(Apr 2025) and
on an
unpublished
manuscriptUM-CDCa
42 48 54 60
84.6%
65.1%72.0%
47.0%____
Outpatient visit
(PO/HO)
____
Hospitalization
(including ICU &
death) and EDPfizerb
12Pfizer (RSVpreF ) and UM-CDC (subunit): Modeled vaccine
effectiveness and duration of protection per outcome
UM-CDCa
The pink -shaded area denotes a higher level of uncertainty of the waning assumption beyond available phase 3 data
a.UM-CDC: Three -year projected effectiveness against ED and hospitalization based on a meta -analysis of real -world vaccine effecti veness studies. Base case truncated at 36
months based on available clinical follow -up extending only through three RSV seasons for a subunit vaccine
b.Pfizer model: Base -case vaccine effectiveness against RSV -Hospital and RSV -ED corresponding to the solid blue line was applied. The dotted blue line reflects vaccine
effectiveness against RSV -Hospital and RSV -ED if the waning pattern would persist.Source : Pfizer
Technical report
and Slides
submitted to
CDC (2024 and
January 2025)
ICU = Intensive
care unit, ED=
Emergency
department,
PO= physician
office, HO =
hospital
outpatientSource : UM -
CDC is based on
Hutton et al.
ACIP
presentation
(Apr 2025) and
on an
unpublished
manuscript
Moderna and UM-CDC: Modeled vaccine
effectiveness and duration of protection per outcome
13UM-CDCa (two-year timeframe: solid lines )
Scenario: 3-year timeframe linear decay, 0% at 36 months: dotted lines
The pink -shaded areas denote a higher level of uncertainty of the waning assumption beyond available phase 3 data
a.UM-CDC base case truncated at 24 months based on available clinical follow -up extending only through a median of <24 months per participant
Source: for Moderna, Moderna's technical report (2025) and for UM -CDC, Hutton et al., ACIP Presentation (Apr 2025) Moderna (three -year timeframe )
ARD = Acute respiratory disease
LRTD =Lower respiratory tract disease
ED = Emergency department86.7%
83.7%
68.4%
____ Vaccine effectiveness for RSV Hospitalization & ED = VE LRTD ≥2 symptoms
____ Vaccine effectiveness for RSV Outpatient= VE medically attended ARD
a.GSK estimated cost -saving values for COPD (base -case) and for each selected individual condition: heart failure, CAD, asthma and di abetes.
b.In the 3 -year timeframe for a generic protein subunit vaccine effectiveness , UM-CDC estimated a societal cost of $ 43,070/QALY saved for adults with at least one
chronic condition (COPD, asthma, CAD, CKD, severe obesity, or diabetes) vaccinated with subunit RSV vaccine. For individual conditions, when vaccinating with a
generic protein subunit RSV vaccine, ICERs ranged from cost -saving (CKD, COPD, BMI ≥40) to $ 57,441 (Diabetes) per QALY saved. When evaluating other specific
conditions not included in “at least one” , $/QALY for adults aged 50 -59 years were also cost -saving (i.e., lung transplant, allogeneic hematopoietic cell transplant, and
autologous hematopoietic cell transplant, heart failure).
Abbreviations : COPD= Chronic obstructive pulmonary disease, CAD=Coronary artery disease, CKD= Chronic kidney disease, ICER= Incremental co st-effectiveness ratio,
BMI = Body mass index, QALY= quality -adjusted life -year Incremental cost -effectiveness:
GSK and UM-CDC
Policy question: What is the incremental cost-effectiveness of vaccinating adults aged 50 -59 years
oldat increased risk of severe RSV illness relative to “No vaccination”?
14GSK UM-CDC
$/QALY saved ( 3-year
timeframe )Cost -saving (COPD)a $44,203b
For a generic protein subunit RSV vaccine:
•Cost -saving: CKD, COPD, BMI≥40
•$9,889 (Asthma)
•$13,177 (CAD)
•$57,441 (Diabetes)
$/QALY saved ( 5-year
timeframe )Cost -saving (COPD)a
(base -case)Not included
a.Pfizer model estimated cost -saving values for selected high -risk conditions: COPD, CAD, CKD, diabetes mellitus, immune compromised an d severe immune compromised.
Base -case used a 3.5 -year vaccine efficacy duration from Phase 3 clinical trials.
b.In the 3 -year timeframe for a generic protein subunit vaccine effectiveness , UM -CDC estimated a societal cost of $ 43,070/QALY saved for adults with at least one chronic condition
(COPD, asthma, CAD, CKD, severe obesity , or diabetes ) vaccinated with subunit RSV vaccine. For individual conditions, when vaccinating with a generic protein subunit RSV vaccine, ICERs
ranged from cost -saving (CKD, COPD, BMI>40) to $57,441 (Diabetes) per QALY saved. When evaluating other specific conditions not included in “at least one” , $/QALY for 50-59 years old
were also cost -saving (i.e., lung transplant, allogeneic hematopoietic cell transplant, autologous hematopoietic cell transplant , and heart failure).
Abbreviations : COPD= Chronic obstructive pulmonary disease, CAD=Coronary artery disease, CKD= Chronic kidney disease, ICER= Incremental co st-effectiveness ratio, BMI =
Body mass index, QALY= quality -adjusted life -year Incremental cost -effectiveness:
Pfizer and UM-CDC
Policy question: What is the incremental cost-effectiveness of vaccinating adults aged 50 -59 years
oldat increased risk of severe RSV illness relative to “No vaccination”?
15Pfizera UM-CDCb
$/QALY saved ( 3- to 3.5 -
year timeframe ) base -caseCost saving $41,754
For a generic protein subunit RSV vaccine:
•Cost -saving: CKD, COPD, BMI≥40
•$9,889 (Asthma)
•$13,177 (CAD)
•$57,441 (Diabetes)
$/QALY saved ( 70 months
timeframe scenario )Cost Saving Not included
a.Moderna reported $/QALY of $40,493 (COPD), $64,289 (CLD), $$61,504 (CKD), $83,598 (Diabetes) and $65,125 (severe obesity, BMI≥ 40.
b.In the base case (2 -year timeframe), UM -CDC estimated a societal cost of $ 152,293/QALY saved for adults with at least one chronic condition (COPD, asthma, CAD, CKD, severe
obesity, or diabetes). When evaluating other specific conditions not included in “at least one,” $/QALY reported were cost -saving (i.e., lung transplant, allogeneic hematopoietic
cell transplant, autologous hematopoietic cell transplant, and heart failure ).
Abbreviations : CHF= Congestive heart failure, COPD= Chronic obstructive pulmonary disease, CLD= Chronic liver disease, CAD=Coronary artery disease, CKD= Chronic kidney disease,
ICER= Incremental cost -effectiveness ratio, BMI = Body mass index, QALY= quality -adjusted life -year Incremental cost -effectiveness:
Moderna and UM-CDC
Policy question: What is the incremental cost-effectiveness of vaccinating adults aged 50 -59 years
oldat increased risk of severe RSV illness relative to “No vaccination”?
16Moderna UM-CDC
$/QALY saved ( 2-year
timeframe )$75,862 $152,293 (Base case)b
For individual conditions costs ranged from
$6,052 (CKD) to
$174,454 (Diabetes) per QALY saved
$/QALY saved ( 3-year
timeframe ) $65,125 (Base case)a
For individual conditions costs ranged
from $10,889 (CHF and heart failure) to
$95,606 (Asthma) per QALY saved$95,182
For individual conditions ranged from cost -
saving (CKD) to $114,315 (Diabetes) per
QALY saved
Limitations
17•Factors not considered that may result in underestimating the cost -effectiveness of RSV
vaccination
•Impact of RSV on long -term prognosis of included higher risk conditions
•Indirect effects of vaccination (i.e., protection against RSV transmission)
•Quality -of-life impact on caregivers during RSV illness
•Two models ( GSK, UM-CDC) do not include, and two models (Moderna, Pfizer ) partially include
•Productivity impact (work time missed) on caregivers during RSV illness
•Manufacturer models do not include RSV-related medical costs incurred after discharge from an RSV -associated
hospitalization or emergency department visit (i.e., stay in long -term care or rehabilitation facility)
•Partially include potential vaccine -associated serious adverse events (SAEs) or Guillain Barre syndrome (GBS): Quality
of life impact, resource utilization, and costs associated with SAEs, including GBS specifically for protein subunit RSV
vaccines.
•Duration of vaccine protection beyond clinical trial follow -up time ( beyond median 19 months,
Moderna ; mean 18 months , Pfizer ormedian 31 months ,GSK) is unknown
•All 4 models assumed non -zero declining efficacy beyond trial time data
•All 4 models assumed optimal timing of vaccination, in the late summer and early fall, prior to
RSV season onset .
Conclusion
18•Differences in key inputs and assumptions among GSK, Moderna , Pfizer and UM-CDC models
explain differences in results:
•Annual incidence of RSV hospitalization and outpatient disease
•Initial vaccine efficacy/effectiveness and waning of protection assumptions
•Medical cost per RSV hospitalization
•Resulting ICERs for policy question also vary by vaccine type and risk condition
•Vaccinating adults aged 50 -59 years old at increased risk of severe RSV disease showed disperse
$/QALY ratios
•Assuming 3 years of vaccine protection:
•Outcomes for PreF combined subunit RSV vaccine ranged from societal cost-saving (GSK and Pfizer models and
for all included high -risk conditions ) to $43,070 per QALY saved ( UM-CDC, though some high -risk conditions were
reported to be cost -saving)
•Outcomes for PreF mRNA RSV vaccine ranged from $65,125 ( Moderna ) to $ 95,182 (UM-CDC) per QALY saved
•Overall, vaccination would significantly reduce RSV disease burden in adults 50 -59 years at
increased risk of severe RSV disease.
•Efficacy data from clinical trials from all vaccines as well as conservative assumptions about
duration of protection support impact on disease reduction and health risks
Acknowledgements
From NCIRD/CDC
•Michael Melgar
•Amadea Britton
•Andrew Leidner
•Ruth Link -Gelles
•Allison Ciesla
•Meredith McMorrow
Also:
•Adult RSV working group members
19
Selected references
20Averin A, Atwood M, Sato R, et al. Attributable Cost of Adult Respiratory Syncytial Virus Illness Beyond the Acute Phase, Open For um Infectious Diseases, Volume 11, Issue 3, March
2024, ofae097, https://doi.org/10.1093/ofid/ofae097
Belongia EA, King JP, Kieke BA, et al. Clinical Features, Severity, and Incidence of RSV Illness During 12 Consecutive Seasons in a Community Cohort of Adults ≥60 Years Old, Open Forum
Infectious Diseases, Volume 5, Issue 12, December 2018, ofy316, https://doi.org/10.1093/ofid/ofy316
Branche AR, Saiman L, Walsh EE, et al. Incidence of Respiratory Syncytial Virus Infection Among Hospitalized Adults, 2017 –2020 , Clinical Infectious Diseases, Volume 74, Issue 6, 15
March 2022, Pages 1004 –1011, https://doi.org/10.1093/cid/ciab595
Falsey AR, Hennessey PA, Formica MA, Cox C, Walsh EE. Respiratory syncytial virus infection in elderly and high -risk adults. N Engl J Med. 2005 Apr 28;352(17):1749 -59. doi:
10.1056/NEJMoa043951. PMID: 15858184. https://doi.org/10.1056/nejmoa043951
Havers FP, Whitaker M, Melgar M, et al. Burden of Respiratory Syncytial Virus -Associated Hospitalizations in US Adults, October 2016 to September 2023. JAMA Netw Open. 2024 Nov
4;7(11):e2444756. doi: 10.1001/jamanetworkopen.2024.44756. PMID: 39535791; PMCID: PMC11561688. https://doi.org/10.1001/jamanetworkopen.2024.44756
La EM, Graham J, Singer D, et al. Cost -effectiveness of the adjuvanted RSVPreF3 vaccine among adults aged ≥60 years in the Unite d States. Hum Vaccin Immunother . 2024 Dec
31;20(1):2432745. https://doi.org/ 10.1080/21645515.2024.2432745
Lopez E, Neuman T, Jacobson G, Levitt L. How Much More Than Medicare Do Private Insurers Pay? A Review of the Literature. Kai ser Family Foundation; 2020. Website, last visited Feb
18,2025 https://www.kff.org/medicare/issue -brief/how -much -more -than -medicare -do-private -insurers -pay-a-review -of-the-literature/
M McLaughlin JM, Khan F, Begier E, et al. Rates of Medically Attended RSV Among US Adults: A Systematic Review and Meta -analysis, Open Forum Infectious Diseas es, Volume 9, Issue
7, July 2022, ofac300, https://doi.org/10.1093/ofid/ofac300
Nguyen -Van-Tam JS, O'Leary M, Martin ET, Heijnen E, Callendret B, Fleischhackl R, Comeaux C, Tran TMP, Weber K. Burden of respiratory syncytial virus infection in older and high -risk
adults: a systematic review and meta -analysis of the evidence from developed countries. Eur Respir Rev. 2022 Nov 15;31(166):220105. doi: 10.1183/16000617.0105 -2022. PMID:
36384703; PMCID: PMC9724807. https://doi.org/10.1183/16000617.0105 -2022
Onwuchekwa C, Moreo LM, Menon S, et al. Underascertainment of Respiratory Syncytial Virus Infection in Adults Due to Diagnostic Testing Limitations: A Systematic Literature Review
and Meta -analysis. J Infect Dis. 2023;228(2):173 -184 https://doi.org/10.1093/infdis/jiad012
Ramirez J, Carrico R, Wilde A, et al. Diagnosis of Respiratory Syncytial Virus in Adults Substantially Increases When Adding Sputum, Saliva, and Serology Testing to Nasopharyngeal Swab
RT PCR. Infect Dis Ther . 2023;12(6):1593 -1603 https://doi.org/10.1007/s40121 -023-00805 -1
Weycker D, Averin A, Houde L, et al. 2207. Rates of Lower Respiratory Tract Infections Among US Adults Aged ≥18 Years With and Without Chronic Medical C onditions. Open Forum
Infectious Diseases. 2022;9(Supplement_2) https://doi.org/10.1093/ofid/ofac492.1826
Wyffels , V., Kariburyo , F., Gavart , S. et al. A Real -World Analysis of Patient Characteristics and Predictors of Hospitalization Among US Medicare Beneficiaries w ith Respiratory Syncytial
Virus Infection. Adv Ther 37, 1203 –1217 (2020). https://doi.org/10.1007/s12325 -020-01230 -3
End of Summary
For more information, contact CDC
1-800-CDC-INFO (232 -4636)
TTY: 1 -888-232-6348 cdc.gov
Follow us on X (Twitter) @CDCgov & @CDCEnvironment
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position o f the U.
S. Centers for Disease Control and Prevention.