Document text
Economic Analysis of RSV Vaccination
in Adults 50 years and Older
David W. Hutton, PhD, MS
Associate Professor, Health Management and Policy, School of Public Health
Associate Professor of Global Public Health, School of Public Health
Associate Professor, Industrial and Operations Engineering, College of Engineering
University of Michigan
1
Research Team
University of Michigan
•David Hutton, PhD
•Lisa Prosser, PhD
•Angela Rose, MPH
•Christina Nyamuswa , MSCDC
•Michael Melgar, MD
•Amadea Britton, MD
•Lauren Roper, MPH
•Mila Prill, MSPH
•Jamison Pike, PhD
•Ismael Ortega -Sanchez, PhD
•Andrew Leidner, PhD
•Fiona Havers, MD
•Michael Whitaker, MPH
•Rebecca Woodruff, PhD
•Huong Pham, MPH
•Bryan Stierman , MD
2
Conflicts of interest statements
•No known conflict of interests.
3
Updates from last presentation before ACIP in
June 2023*
•Risk-Based Analysis
•Groups based on chronic medical conditions (CMCs) and age
•Added Moderna Vaccine
•Other New Inputs
•RSV Epidemiology
•Hospitalization incidence by chronic medical conditions
•Outpatient incidence by chronic medical condition
•RSV-mortality inclusive of deaths in and out of hospital
•Real -world observational vaccine effectiveness of RSV protein subunit vaccination
(Pfizer/GSK)
•Duration of protection derived from clinical trial efficacy waning over time using all available
follow up time
•Vaccine adverse events after protein subunit RSV vaccination
•Real world evidence on local and systemic vaccine reactions (V -safe)
•Risk of Guillain -Barre syndrome (GBS) observed after RSV vaccination in administrative claims
data through FDA/CMS partnership
4* DW Hutton, “Economic Analysis of RSV Vaccination in Older Adults” June 21, 2023 (cdc.gov)
Methods
5
Methods: Study question
•Determine the cost -effectiveness of RSV vaccination by:
•Comparing vaccination to no vaccination using the incremental cost -
effectiveness ratio
•Scenario analyses.
•Perspective: Societal
6
Methods: Intervention(s)
•Target population: US adults aged ≥50 years, stratified by age, chronic
medical conditions
•Adults aged ≥75 years
•Adults aged 60 -74 years with at least one chronic medical condition*
•Adults aged 50 -59 years with at least one chronic medical condition*
•Interventions: RSV vaccination
•Protein subunit RSV vaccination (Pfizer’s ABRYSVO, GSK’s AREXVY)
•Moderna RSV vaccination (Moderna’s mRESVIA )
•Each compared to no vaccination
7*At least one of: chronic obstructive pulmonary disease (COPD), asthma, coronary artery disease, chronic kidney disease,
diabetes mellitus, severe obesity (BMI ≥40)
Combining Pfizer and GSK in base case
•ACIP has previously seen that product -specific cost effectiveness for
the two currently licensed protein subunit RSV vaccines is similar
•Policy question does not distinguish between the two products
•Combining products allows simplification of results and enables us to
focus on the policy questions
•Product -specific results will still be shown in scenario analyses
•Benefit/risk analyses evaluating GBS risk will be shown at the end and
continue to be product -specific, understanding whether there is
meaningful difference between products in terms of benefit/risk
balance
8
Methods: Decision Tree Model
9No
Vaccination
VaccinationInfection Hospitalization
ED
None of the aboveOutpatientAlive
Dead
RSV Infection
Adverse
EventsSystemic Reaction
Injection Site Reaction
None of the aboveSerious Adverse EventInfection RSV Infection
Guillain Barre Syndrome
Annual RSV Incidence
•Hospitalization s
•RSV-NET estimated annual hospitalizations per 100,000 population (adjusted for under -
detection, including a 1.5x multiplier to account for RSV test sensitivity)
•Source, age stratification only: Havers et al. manuscript draft, 2016 -2020
•Source, stratification by age AND presence/absence of chronic medical conditions: Update to Woodruff
et al. analysis presented to ACIP in February 2024, 2017 -20181
•Emergency Department visits:
•From McLaughlin et al. meta -analysis2 (main results incorporating a 1.5x multiplier to account
for RSV laboratory test sensitivity).
•No differences by presence or absence of chronic medical conditions*
•Outpatient:
•The base values ( all-comers ) are from the McLaughlin et al. meta -analysis.2
•Values for adults with chronic cardiopulmonary conditions (e.g., COPD) are drawn from
Belongia et al.3 and multiplied by 1.5x for test sensitivity to align with RSV -NET and
McLaughlin et al. methods.
•Non -cardiopulmonary conditions (e.g., diabetes) utilize the base values (same as for all -
comers)
*Values were assumed to be the same for adults with and without chronic medical conditions. This is a conservative assumption mad e in the absence of reliable risk -stratified data on the
incidence of emergency department visits.
1. https://www.cdc.gov/vaccines/acip/meetings/downloads/slides -2024 -02-28-29/03 -RSV-Adults -Woodruff -508.pdf
2. Pfizer -sponsored: McLaughlin JM, et al. Rates of Medically Attended RSV Among US Adults: A Systematic Review and Meta -analysis. Open Forum Infect Dis. 2022 J un 17;9(7):ofac300. doi:
10.1093/ ofid/ofac300. PMID: 35873302; PMCID: PMC9301578.
3. Novavax sponsored: Belongia EA, et al. Clinical features, severity, and incidence of RSV illness during 12 consecutive seasons in a community cohort of a dults ≥60 years old. In Open forum infectious
diseases 2018 Dec (Vol. 5, No. 12, p. ofy316). US: Oxford University Press10
Annual RSV incidence
•At least one chronic medical condition (source RSV -NET):
•Chronic obstructive pulmonary disease (COPD), OR
•Asthma, OR
•Coronary artery disease (CAD), OR
•Diabetes mellitus, OR
•Chronic kidney disease (CKD), OR
•Severe obesity (body mass index [BMI] ≥40 kg/m2)
•Additional chronic medical conditions evaluated in scenario analyses:
•Heart failure1
•Immune compromised
•Lung transplant2
•Hematopoietic cell transplant, allogeneic3,4
•Hematopoietic cell transplant, autologous3,4
1. Kujawski SA, et al. Rates of respiratory syncytial virus (RSV) -associated hospitalization among adults with congestive heart failure -United States, 2015 -2017. PLoS One. 2022
Mar 9;17(3):e0264890. doi: 10.1371/journal.pone.0264890
2. Testaert H, et al. Incidence, management and outcome of respiratory syncytial virus infection in adult lung transplant recipients: a 9 -year retrospective multicentre study. Clin
Microbiol Infect. 2021 Jun;27(6):897 -903. doi: 10.1016/j.cmi.2020.07.050.
3. Martino R, et al. Prospective study of the incidence, clinical features, and outcome of symptomatic upper and lower respirato ry tract infections by respiratory viruses in adult
recipients of hematopoietic stem cell transplants for hematologic malignancies. Biol Blood Marrow Transplant. 2005 Oct;11(10) :781-96. doi: 10.1016/j.bbmt.2005.07.007
4. Waghmare A, et al. Supplemental Oxygen -Free Days in Hematopoietic Cell Transplant Recipients With Respiratory Syncytial Virus. J Infect Dis. 2017 Dec 5;216(10):1235 -1244.
doi: 10.1093/ infdis /jix390These conditions are considered separately
because RSV epidemiologic parameters were
derived from different published sources and
cannot be combined with RSV -NET hospitalization
rate estimates under “at least one” condition.
11
Annual RSV incidence
•At least one chronic medical condition (source RSV -NET):
•Chronic obstructive pulmonary disease (COPD), OR
•Asthma, OR
•Coronary artery disease (CAD), OR
•Diabetes mellitus, OR
•Chronic kidney disease (CKD), OR
•Severe obesity (body mass index [BMI] ≥40 kg/m2)
•Additional chronic medical conditions evaluated in scenario analyses:
•Heart failure1
•Immune compromised
•Lung transplant2
•Hematopoietic cell transplant, allogeneic3,4
•Hematopoietic cell transplant, autologous3,4
121. Kujawski SA, et al. Rates of respiratory syncytial virus (RSV) -associated hospitalization among adults with congestive heart failure -United States, 2015 -2017. PLoS One. 2022 Mar
9;17(3):e0264890. doi: 10.1371/journal.pone.0264890
2. Testaert H, et al. Incidence, management and outcome of respiratory syncytial virus infection in adult lung transplant recipients: a 9 -year retrospective multicentre study. Clin
Microbiol Infect. 2021 Jun;27(6):897 -903. doi: 10.1016/j.cmi.2020.07.050.
3. Martino R, et al. Prospective study of the incidence, clinical features, and outcome of symptomatic upper and lower respirato ry tract infections by respiratory viruses in adult
recipients of hematopoietic stem cell transplants for hematologic malignancies. Biol Blood Marrow Transplant. 2005 Oct;11(10) :781-96. doi: 10.1016/j.bbmt.2005.07.007
4. Waghmare A, et al. Supplemental Oxygen -Free Days in Hematopoietic Cell Transplant Recipients With Respiratory Syncytial Virus. J Infect Dis. 2017 Dec 5;216(10):1235 -1244.
doi: 10.1093/ infdis /jix390Assumed that vaccine effectiveness was
reduced by half in immune compromised
populations, compared with all others
Vaccine effectiveness (VE) of a single dose over time:
protein subunit RSV vaccine (combined Pfizer/GSK)
13Linear decay to 0%
by 24 months74%
33%
17%78%
58%
33%80%
60%
34%
0%10%20%30%40%50%60%70%80%90%100%
0 6 12 18 24 30 36Efficacy
Months since vaccination
Outpatient ED Hospitalization
VE against hospitalization and emergency department visits during months 0 -6 post -vaccination was assumed to be equal to results of a meta -analysis of observational VE
estimates from CDC and Veterans Health Administration analyses from the first RSV season of vaccine availability. Proportiona l waning was applied from clinical trial vaccine
efficacy over time against RSV lower respiratory tract illness with ≥3 signs/symptoms (Pfizer ABRYSVO) and RSV lower respirat ory tract disease (GSK AREXVY) (data provided by
manufacturers). VE against outpatient illness was assumed to be the mean across the two products of trial efficacy against RS V acute respiratory illness.
0%10%20%30%40%50%60%70%80%90%100%
0 6 12 18 24 30 36Efficacy
Months since vaccination
Outpatient ED HospitalizationVaccine effectiveness (VE) of a single dose over time:
Moderna RSV vaccine ( mRESVIA )
1475%
54%
Linear decay to 0%
by 24 months54%
VE against hospitalization during months 0 -9 post -vaccination was assumed to be equal to clinical trial vaccine efficacy against medically attended RSV lower respiratory tract
disease with ≥3 signs/symptoms. VE against emergency department visits and outpatient illness during months 0 -9 was assumed to b e equal to clinical vaccine efficacy against
medically attended RSV acute respiratory illness. VE was assumed to decline to zero by month 24 post -vaccination.
•Pfizer and GSK systemic and injection site adverse event rates updated based on real -world V -
safe data:
•Pfizer: 6% experienced severe injection site reaction or systemic reaction
•GSK: 10% experienced severe injection site reaction or systemic reaction
•Pfizer and GSK Guillain Barre syndrome (GBS) risk updated based on FDA active surveillance
through partnership with CMS, Medicare beneficiaries ages ≥65 years1, vaccinations during
May –October 8, 2023:
•Pfizer: 16 GBS cases (95% CI 3 –29) per 1 million doses administered2
•GSK: 3 GBS cases (95% CI 0 –10) per 1 million doses administered2,3
•Moderna data based on trial
•Moderna: 7% experienced severe injection site reaction or systemic reaction
•Assumed no vaccine -attributable GBS risk
•All Vaccines: rare, unnamed serious adverse event of 1 per million doses administered
15Methods: Adverse Events
Abbreviations: CI = confidence interval, CMS = Centers for Medicare & Medicaid Services, FDA = U.S. Food and Drug Administrat ion, GBS = Guillain -Barre
syndrome
1.Must have been enrolled in Medicare Parts A, B and D. Must not have had a diagnostic code for GBS in the 365 days preceding v accination.
2.These estimates reflect vaccine -attributable risk of GBS in excess of background rate of GBS among adults ages ≥65 years vaccina ted with the same product.
This analysis extrapolated from the study population and assumed the same risk applied to adults ages 50 –64 years.
3.Attributable risk for GSK’s AREXVY was estimated to be 3 GBS cases (95% CI: -3, 10) per 1 million doses. For mathematical modeling , lower end of the 95% CI
was truncated at 0 to evaluate potential risk of GBS. Potential protective effects were not evaluated.
Methods: Base RSV Medical Costs
Variable Value Range Source
Disease -specific hospitalization costs (per hospitalization)
age 50 to <60 years $20,330 9,511 – 39,544
Ackerson 2020*age 60 to <65 years $21,417 9,288 – 45,454
age 65 to <75 years $21,417 10,491 – 43,619
age ≥75 years $22,425 10,491 – 43,619
Disease -specific ED costs (per ED visit)
age 60 to <65 years $1,210 -
2016 Marketscan* age 65 to <75 years $1,210 -
age ≥75 years $1,210 -
Disease -specific outpatient costs (per outpatient visit)
age 60 to <65 years $117.58 65.88 -145.38MarketScan and Medicare FFS,
2020 -2021age 65 to <75 years $100.86 50.48 -120.08
age ≥75 years $100.86 50.48 -120.08
16
*Updated to 2023 using GDP Deflator
Methods: Hospitalization cost multiplier based on chronic
medical conditions
17Condition Condition -specific multiplier, based on median length of stay (RSV -NET)
At least one condition* 1.06
With COPD 1.22
With Asthma 1.0
With CAD 1.13
With Diabetes 1.11
With severe obesity, BMI ≥40 1.0
With CKD 1.26
None of these conditions** 0.84
With Heart Failure 1.28
Immune Compromise 1.06
*Have at least one of: chronic obstructive pulmonary disease, asthma, coronary artery disease, diabetes mellitus, severe obesity (BMI ≥40), chronic kidney
disease; may also have other conditions such as heart failure or immune compromise
** None of the conditions in the at least one definition, but may have other conditions such as heart failure or immune compr omise
Methods: Vaccination -Related Costs
Variable Value Range Source
Vaccine, per dose
Pfizer $295 List price
GSK $280 List price
Moderna $290 Manufacturer Assumption
Vaccine administration $16.96 -HCPCS 90460 (Physician Fee Schedule
2022)
18
Methods: Additional Inputs
•Also included
•RSV illness QALYs lost
•RSV illness productivity costs
•Vaccination healthcare and productivity costs
•Vaccination adverse events
•Medical costs
•Productivity costs
•These assumptions remain unchanged from October 2023
19* DW Hutton, “Economic Analysis of RSV Vaccination in Older Adults” June 21, 2023 (cdc.gov)
Methods: Scenarios
•Manufacturer -specific (Pfizer and GSK -specific models; Moderna is
considered separately in the base case, so no scenario needed)
•Assuming longer duration of protection (efficacy declines to 0 at 36
rather than at 24 months)
•Among persons without chronic medical conditions
•Condition -specific (e.g., among persons with heart failure)
20
Base case results
21
Base case Incremental Cost -Effectiveness
Ratios ($/QALY)
Protein subunit RSV
vaccines
(combined Pfizer + GSK)Moderna RSV vaccine
All adults 75+ $ 51,447 $ 66,287
Adults 60 -74 with at
least 1 condition1 $ 60,933 $ 80,953
Adults 50 -59 with at
least 1 condition1,2 $ 154,501
1. At least one of: chronic obstructive pulmonary disease, asthma, coronary artery disease, diabetes mellitus, chronic
kidney disease, severe obesity (BMI ≥40)
2. Only a single vaccine (GSK AREXVY) is licensed in adults 50 -59. So, this uses GSK -specific input parameters for this
age group.
BMI: body mass index, QALY: Quality -Adjusted Life -Year 22
Incremental Cost -Effectiveness
QALY: Quality -Adjusted Life -Year
23At least one of: chronic obstructive pulmonary disease, asthma, coronary artery disease, diabetes mellitus, chronic kidney di sease, severe obesity
(BMI ≥40)Protein subunit vaccine All
adults ≥75
$- $500 $1,000 $1,500 $2,000 $2,500 $3,000
- 5 10 15 20 25 30 35 40Incremental Societal Costs (Millions)
Incremental QALYs Saved (Thousands)
Incremental Cost -Effectiveness
QALY: Quality -Adjusted Life -Year
24At least one of: chronic obstructive pulmonary disease, asthma, coronary artery disease, diabetes mellitus, chronic kidney di sease, severe obesity
(BMI ≥40)Protein subunit vaccine All
adults ≥75 $51,447/QALY
$- $500 $1,000 $1,500 $2,000 $2,500 $3,000
- 5 10 15 20 25 30 35 40Incremental Societal Costs (Millions)
Incremental QALYs Saved (Thousands)
Incremental Cost -Effectiveness
QALY: Quality -Adjusted Life -Year
25At least one of: chronic obstructive pulmonary disease, asthma, coronary artery disease, diabetes mellitus, chronic kidney di sease, severe obesity
(BMI ≥40)Protein subunit vaccine All
adults ≥75Protein subunit vaccine All
adults ≥75 AND 60 -74 with at
least 1 condition
$51,447/QALY$60,933/QALY
$- $500 $1,000 $1,500 $2,000 $2,500 $3,000
- 5 10 15 20 25 30 35 40Incremental Societal Costs (Millions)
Incremental QALYs Saved (Thousands)
Incremental Cost -Effectiveness
QALY: Quality -Adjusted Life -Year
26At least one of: chronic obstructive pulmonary disease, asthma, coronary artery disease, diabetes mellitus, chronic kidney di sease, severe obesity
(BMI ≥40)Protein subunit vaccine All
adults ≥75Protein subunit vaccine All
adults ≥75 AND 60 -74 with at
least 1 conditionProtein subunit vaccine All
adults ≥75 AND 60 -74 with at
least 1 condition AND 50 -59
with at least 1 condition
$51,447/QALY$60,933/QALY$154,501/QALY
$- $500 $1,000 $1,500 $2,000 $2,500 $3,000
- 5 10 15 20 25 30 35 40Incremental Societal Costs (Millions)
Incremental QALYs Saved (Thousands)
Incremental Cost -Effectiveness
QALY: Quality -Adjusted Life -Year
27At least one of: chronic obstructive pulmonary disease, asthma, coronary artery disease, diabetes mellitus, chronic kidney di sease, severe obesity
(BMI ≥40)Protein subunit vaccine All
adults ≥75Protein subunit vaccine All
adults ≥75 AND 60 -74 with at
least 1 conditionProtein subunit vaccine All
adults ≥75 AND 60 -74 with at
least 1 condition AND 50 -59
with at least 1 condition
Moderna vaccine All adults ≥75
$51,447/QALY$60,933/QALY$154,501/QALY
$66,287/QALY
$- $500 $1,000 $1,500 $2,000 $2,500 $3,000
- 5 10 15 20 25 30 35 40Incremental Societal Costs (Millions)
Incremental QALYs Saved (Thousands)
Incremental Cost -Effectiveness
QALY: Quality -Adjusted Life -Year
28At least one of: chronic obstructive pulmonary disease, asthma, coronary artery disease, diabetes mellitus, chronic kidney di sease, severe obesity
(BMI ≥40)Protein subunit vaccine All
adults ≥75Protein subunit vaccine All
adults ≥75 AND 60 -74 with at
least 1 conditionProtein subunit vaccine All
adults ≥75 AND 60 -74 with at
least 1 condition AND 50 -59
with at least 1 condition
Moderna vaccine All adults ≥75Moderna vaccine All adults ≥75
AND 60 -74 with at least 1
condition
$51,447/QALY$60,933/QALY$154,501/QALY
$66,287/QALY$80,953/QALY
$- $500 $1,000 $1,500 $2,000 $2,500 $3,000
- 5 10 15 20 25 30 35 40Incremental Societal Costs (Millions)
Incremental QALYs Saved (Thousands)
Scenario analyses
29
Protein subunit RSV vaccination: product -
specific
GSK AREXVY Pfizer ABRYSVO
All adults 75+ $ 47,050 $ 58,739
Adults 60 -74 with at
least 1 condition$ 55,006 $ 70,624
30At least one of: chronic obstructive pulmonary disease, asthma, coronary artery disease, diabetes mellitus,
chronic kidney disease, severe obesity (BMI ≥40)
Time Horizon Comparison
Base case (24 months of efficacy )
Protein subunit RSV
vaccines
(combined Pfizer +
GSK)Moderna RSV
vaccineProtein subunit RSV
vaccines
(combined
Pfizer+GSK )Moderna RSV
vaccine
All adults 75+ $ 51,447 $ 66,287 $ 39,833 $ 42,495
Adults 60 -74
with at least 1
condition$ 60,933 $ 80,953 $ 45,445 $ 49,198
Adults 50 -59
with at least 1
condition*$ 154,501 $ 112,949 Scenario (36 months of efficacy )
*Only a single manufacturer (GSK) has applied for FDA licensure in adults 50 -59. So, this scenario uses GSK -specific inputs.
31At least one of: chronic obstructive pulmonary disease, asthma, coronary artery disease, diabetes mellitus, chronic kidney di sease,
severe obesity (BMI ≥40)
Cost -Effectiveness by age and conditions
* At least one of: chronic obstructive pulmonary disease, asthma, coronary artery disease, diabetes mellitus, chronic kidney disease, severe obesity (BMI ≥40)
** None of the above conditions. Persons may have other chronic medical conditions (e.g., heart failure, non -severe obesity, imm une compromise).32$14,636 $60,933 $154,501
$22,905 $80,953 $168,075 $505,385
$202,918 $608,761
$- $100,000 $200,000 $300,000 $400,000 $500,000 $600,000 $700,000
Adults ≥75 Adults 60-74 Adults 50-59 Adults ≥75 Adults 60-74
Protein subunit vaccine GSK Moderna vaccineICER ($ per QALY gained)
At least one condition* None of these conditions**
Scenarios: Cost -effectiveness of vaccinating adults with
specific chronic conditions
Protein subunit RSV
vaccines
(combined Pfizer+GSK )Moderna RSV vaccine
Adults 60 -74 with specific
conditions : heart failure,
immune compromise,
COPD, asthma, CAD,
diabetes, severe obesity,
chronic kidney disease10 Scenarios 10 Scenarios
Adults 50 -59 with specific
conditions : as above10 Scenarios
(GSK -specific)*
*Only a single vaccine (GSK AREXVY) is licensed in adults 50 -59. So, this uses GSK -specific inputs for this age group.33
$0 $25,000 $50,000 $75,000 $100,000 $125,000 $150,000 $175,000 $200,000
All Adults
At least one condition
CKD
COPD
obesity BMI >40
Asthma
CAD
Diabetes
None of the above…
Heart Failure
With lung transplant
With allogenic HCT
With autologous HCTIncremental cost effectiveness ratio ($ per QALY gained)
50-59
60-74
≥75Scenarios: Adults with specific chronic medical conditions, protein subunit RSV
vaccines (Pfizer/GSK)
*Indicates cost saving
At least one condition refers to: COPD, asthma, coronary artery disease, diabetes
mellitus, chronic kidney disease, severe obesity (BMI ≥40)//$505,385**
*Adults 50 -59 without chronic conditions are not under consideration
Adults 50 -59 without chronic conditions are not under consideration
*
**
†Only a single vaccine (GSK AREXVY) is licensed in adults 50 -59. So, this uses GSK -specific inputs for
this age group.
HCT: Hematopoietic Cell Transplant†
$0 $25,000 $50,000 $75,000 $100,000 $125,000 $150,000 $175,000 $200,000
All Adults
At least one condition
CKD
COPD
obesity BMI >40
Asthma
CAD
Diabetes
None of the above…
Heart Failure
With lung transplant
With allogenic HCT
With autologous HCTIncremental cost effectiveness ratio ($ per QALY gained)
60-74
≥75Scenarios: Adults with specific chronic medical conditions, Moderna RSV vaccine
*
*
//$608,761
//$202,918//$217,582
*
*
*
*Indicates cost saving
At least one condition refers to: COPD, asthma, coronary artery disease, diabetes mellitus, chronic kidney disease, severe ob esity (BMI ≥40)
HCT: Hematopoietic Cell Transplant
Sensitivity Analysis:
Changing Parameter Assumptions
36
GSK RSV vaccine at least 1 condition age 50 -59
37$0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000
Incidence of RSV hospitalization
RSV-attributable mortality
RSV QALYs Lost Outpatient Adult
Cost per Hospitalization
VE GSK Hospitalized months 13-23
VE GSK Outpatient months 13-23
Health Utility Age 60-69 years
VE GSK Hospitalized months 0-7
Incidence of outpatient visits for RSV
GBS Cases per MillionIncremental Cost -Effectiveness Ratio ($/QALY gained)As least one condition Age 50 -59 years GSK
Low Assumption High Assumption
Limitations
•Model Structure
•No dynamic transmission. No impact of the vaccine on transmission and indirect
effects
•We did not include or analyze all potential RSV risk factors.
•Some medical conditions (e.g., interstitial lung disease) are likely associated with
high risk of severe RSV disease, but literature on population -based hospitalization
rates and other outcomes are lacking.
•RSV vaccination may be cost effective for adults with additional conditions that were
not evaluated.
•Uncertain inputs
•Moderna real -world vaccine effectiveness
•Moderna vaccine cost
•RSV burden of disease, especially hospitalization and mortality
•Duration and waning pattern of vaccine protection
38
Conclusions
•If there were a recommendation for RSV vaccination for all adults 75 and older the ICER
would be $51,447 societal cost/QALY saved (Pfizer/GSK) and $66,287/QALY (Moderna) .
•If instead we limited the recommendation only to adults 75 and older with at least one chronic
medical condition the ICER would be $14,636/QALY (Pfizer/GSK) and $22,905 (Moderna)
•If we add in adults 60-74 with at least one chronic medical condition , the ICER would be
$60,933 societal cost/QALY (Pfizer/GSK) and $80,953/QALY (Moderna) .
•Vaccination of adults 60 -74 without chronic conditions has an ICER of $505,385/QALY (Pfizer/GSK)
and $608,761/QALY (Moderna)
•If we add in adults 50-59 with at least one chronic medical condition the ICER would be
$154,501 societal cost/QALY saved (GSK only).
•By specific condition, $/QALY saved was lowest among adults 50 -59 with heart failure
($14,335/QALY ) and immune compromise ( cost-saving or $14,521/QALY ) and highest among
those with diabetes ($171,661/QALY ).
•Longer duration of protection (36 months rather than 24 months) or higher baseline RSV
disease burden made all policy options more cost effective.
39
Thank You
•Please send comments to:
•[email protected]
40
41Methods: Epidemiology
RSV Hospitalization Incidence by Age and Chronic Medical
Condition “back -up slide not shown at meeting"
Source: CDC RSV -NET data from RSV seasons: 2016 -17, 2017 -18, 2018 -19, 2019 -2020
* At least one of: chronic obstructive pulmonary disease, asthma, coronary artery disease, diabetes mellitus, chronic kidney disease, severe obesity (BMI ≥40)
** None of the above conditions. Persons may have other chronic medical conditions (e.g., heart failure, non -severe obesity, imm une compromise).050010001500200025003000350040004500RSV-associated Hospitalizations
per 100,000
Age 50-59 years Age 60-74 years Age ≥75 years