Comparison of the public health impact of RSV disease prevention options for infants: a static decision model of the US birth cohort
Alexia Kieffer, Mehdi Ghemmouri, Samira Soudani, Thomas Shin, Erin N. Hodges, Michael E. Greenberg, Maribel Tribaldos, Ayman Chit, Matthieu Beuvelet, Maureen P. Neary, Veronica Gabriel, Leonard R. Krilov, Jeroen Geurtsen, Robert Musci, Benjamin Yarnoff
Abstract
BACKGROUND: In the U.S.A. three prophylactic interventions are approved for the prevention of respiratory syncytial virus (RSV) lower respiratory tract disease (LRTD) in infants: nirsevimab and clesrovimab (extended half-life monoclonal antibodies) and the maternal RSVpreF vaccine. We compared the impact of these interventions on RSV-LRTD events and costs versus the previous standard-of-practice (SoP; palivizumab-only strategy). RESEARCH DESIGN AND METHODS: Using a static decision-analytic model, we estimated the public health impact of nirsevimab, clesrovimab, and RSVpreF following the latest recommendations on RSV-related outcomes and costs in a US birth cohort during their first RSV season compared to the pre-2023 SoP. RESULTS: The model estimated that nirsevimab would avert 364,204 RSV-LRTDs including 32,404 hospitalizations, saving $1,289 million in direct and indirect costs. Depending on the assumed duration of protection, clesrovimab was estimated to avert 173,276-261,358 RSV-LRTDs of which 23,957-30,483 were hospitalizations, resulting in savings of $912-$1,150 million in total costs. RSVpreF maternal vaccination would avert 76,915 RSV-LRTDs including 9,649 hospitalizations, equating to $345 million in total cost savings. CONCLUSIONS: While all three interventions are estimated to reduce RSV-LRTD burden in infants, all-infant protection with nirsevimab was estimated to avert more events and associated medical costs for all infant subgroups compared to clesrovimab or RSVpreF.