Optimal Respiratory Syncytial Virus intervention programmes using Nirsevimab in England and Wales

David Hodgson; Mihaly Koltai; Fabienne Krauer; Stefan Flasche; Mark Jit; Katherine E Atkins

doi:10.1016/j.vaccine.2022.10.041

Optimal Respiratory Syncytial Virus intervention programmes using Nirsevimab in England and Wales

David Hodgson, Mihaly Koltai, Fabienne Krauer, Stefan Flasche, Mark Jit, Katherine E Atkins

Research output: Contribution to journal › Article › peer-review

Abstract / Description of output

INTRODUCTION: Respiratory Syncytial Virus (RSV) is a major cause of acute lower respiratory tract infections (ALRI) in infants. There are no licensed vaccines and only one monoclonal antibody available to protect infants from disease. A new and potentially longer-lasting monoclonal antibody, Nirsevimab, showed promising results in phase IIb/III trials. We evaluate the cost-effectiveness of Nirsevimab intervention programmes in England and Wales.

METHODS: We used a dynamic model for RSV transmission, calibrated to data from England and Wales. We considered a suite of potential Nirsevimab programmes, including administration to all neonates (year-round); only neonates born during the RSV season (seasonal); or neonates born during the RSV season plus infants less than six months old before the start of the RSV season (seasonal + catch-up).

RESULTS: If administered seasonally to all infants at birth, we found that Nirsevimab would have to be priced at £63 or less per dose for at least 50% certainty that it could cost-effectively replace the current Palivizumab programme, using an ICER threshold of £20,000/QALY. An extended seasonal programme which includes a pre-season catch-up becomes the optimal strategy at a purchasing price of £32/dose or less for at least 50% certainty. At a purchasing price per dose of £5-32, the annual implementation costs of a seasonal programme could be as high as £2 million before a switch to a year-round strategy would be optimal.

DISCUSSION: Nirsevimab has the potential to be cost-effective in England and Wales not only for use in high-risk infants.

Original language	English
Pages (from-to)	7151-7157
Number of pages	7
Journal	Vaccine
Volume	40
Issue number	49
Early online date	31 Oct 2022
DOIs	https://doi.org/10.1016/j.vaccine.2022.10.041
Publication status	Published - 22 Nov 2022

Keywords / Materials (for Non-textual outputs)

Cost-effectiveness analysis
Economic model
Monoclonal antibodies
RSV

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10.1016/j.vaccine.2022.10.041

1-s2.0-S0264410X22013007-mainFinal published version, 517 KBLicence: Creative Commons: Attribution (CC-BY)

Cite this

@article{4bf9f1ad3e574c80a143295c0d7bebad,

title = "Optimal Respiratory Syncytial Virus intervention programmes using Nirsevimab in England and Wales",

abstract = "INTRODUCTION: Respiratory Syncytial Virus (RSV) is a major cause of acute lower respiratory tract infections (ALRI) in infants. There are no licensed vaccines and only one monoclonal antibody available to protect infants from disease. A new and potentially longer-lasting monoclonal antibody, Nirsevimab, showed promising results in phase IIb/III trials. We evaluate the cost-effectiveness of Nirsevimab intervention programmes in England and Wales.METHODS: We used a dynamic model for RSV transmission, calibrated to data from England and Wales. We considered a suite of potential Nirsevimab programmes, including administration to all neonates (year-round); only neonates born during the RSV season (seasonal); or neonates born during the RSV season plus infants less than six months old before the start of the RSV season (seasonal + catch-up).RESULTS: If administered seasonally to all infants at birth, we found that Nirsevimab would have to be priced at £63 or less per dose for at least 50% certainty that it could cost-effectively replace the current Palivizumab programme, using an ICER threshold of £20,000/QALY. An extended seasonal programme which includes a pre-season catch-up becomes the optimal strategy at a purchasing price of £32/dose or less for at least 50% certainty. At a purchasing price per dose of £5-32, the annual implementation costs of a seasonal programme could be as high as £2 million before a switch to a year-round strategy would be optimal.DISCUSSION: Nirsevimab has the potential to be cost-effective in England and Wales not only for use in high-risk infants.",

keywords = "Cost-effectiveness analysis, Economic model, Monoclonal antibodies, RSV",

author = "David Hodgson and Mihaly Koltai and Fabienne Krauer and Stefan Flasche and Mark Jit and Atkins, {Katherine E}",

note = "Funding Information: DH was funded by the National Institutes of Health (1R01AI141534-01A1). MK and FK were funded by Innovation Fund of the Joint Federal Committee (grant no. 01VSF18015). FK was funded by Wellcome Trust (grant no. 221303/Z/20/Z). SF was funded by Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society (Grant Number208812/Z/17/Z). MJ was supported by the NIHR HPRU in Modelling and Health Economics (grant code HPRU-2019-NIHR200908) and the NIHR in Immunisation HPRU-2019-NIHR200929). None of the funding sources of any of the authors had involvement in this study. The views expressed are those of the authors and not necessarily those of the UK Department of Health and Social Care, the National Health Service, the National Institute for Health Research (NIHR), or UK Health Security Agency. Publisher Copyright: {\textcopyright} 2022 The Author(s)",

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doi = "10.1016/j.vaccine.2022.10.041",

language = "English",

volume = "40",

pages = "7151--7157",

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T1 - Optimal Respiratory Syncytial Virus intervention programmes using Nirsevimab in England and Wales

AU - Hodgson, David

AU - Koltai, Mihaly

AU - Krauer, Fabienne

AU - Flasche, Stefan

AU - Jit, Mark

AU - Atkins, Katherine E

N1 - Funding Information: DH was funded by the National Institutes of Health (1R01AI141534-01A1). MK and FK were funded by Innovation Fund of the Joint Federal Committee (grant no. 01VSF18015). FK was funded by Wellcome Trust (grant no. 221303/Z/20/Z). SF was funded by Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society (Grant Number208812/Z/17/Z). MJ was supported by the NIHR HPRU in Modelling and Health Economics (grant code HPRU-2019-NIHR200908) and the NIHR in Immunisation HPRU-2019-NIHR200929). None of the funding sources of any of the authors had involvement in this study. The views expressed are those of the authors and not necessarily those of the UK Department of Health and Social Care, the National Health Service, the National Institute for Health Research (NIHR), or UK Health Security Agency. Publisher Copyright: © 2022 The Author(s)

PY - 2022/11/22

Y1 - 2022/11/22

N2 - INTRODUCTION: Respiratory Syncytial Virus (RSV) is a major cause of acute lower respiratory tract infections (ALRI) in infants. There are no licensed vaccines and only one monoclonal antibody available to protect infants from disease. A new and potentially longer-lasting monoclonal antibody, Nirsevimab, showed promising results in phase IIb/III trials. We evaluate the cost-effectiveness of Nirsevimab intervention programmes in England and Wales.METHODS: We used a dynamic model for RSV transmission, calibrated to data from England and Wales. We considered a suite of potential Nirsevimab programmes, including administration to all neonates (year-round); only neonates born during the RSV season (seasonal); or neonates born during the RSV season plus infants less than six months old before the start of the RSV season (seasonal + catch-up).RESULTS: If administered seasonally to all infants at birth, we found that Nirsevimab would have to be priced at £63 or less per dose for at least 50% certainty that it could cost-effectively replace the current Palivizumab programme, using an ICER threshold of £20,000/QALY. An extended seasonal programme which includes a pre-season catch-up becomes the optimal strategy at a purchasing price of £32/dose or less for at least 50% certainty. At a purchasing price per dose of £5-32, the annual implementation costs of a seasonal programme could be as high as £2 million before a switch to a year-round strategy would be optimal.DISCUSSION: Nirsevimab has the potential to be cost-effective in England and Wales not only for use in high-risk infants.

AB - INTRODUCTION: Respiratory Syncytial Virus (RSV) is a major cause of acute lower respiratory tract infections (ALRI) in infants. There are no licensed vaccines and only one monoclonal antibody available to protect infants from disease. A new and potentially longer-lasting monoclonal antibody, Nirsevimab, showed promising results in phase IIb/III trials. We evaluate the cost-effectiveness of Nirsevimab intervention programmes in England and Wales.METHODS: We used a dynamic model for RSV transmission, calibrated to data from England and Wales. We considered a suite of potential Nirsevimab programmes, including administration to all neonates (year-round); only neonates born during the RSV season (seasonal); or neonates born during the RSV season plus infants less than six months old before the start of the RSV season (seasonal + catch-up).RESULTS: If administered seasonally to all infants at birth, we found that Nirsevimab would have to be priced at £63 or less per dose for at least 50% certainty that it could cost-effectively replace the current Palivizumab programme, using an ICER threshold of £20,000/QALY. An extended seasonal programme which includes a pre-season catch-up becomes the optimal strategy at a purchasing price of £32/dose or less for at least 50% certainty. At a purchasing price per dose of £5-32, the annual implementation costs of a seasonal programme could be as high as £2 million before a switch to a year-round strategy would be optimal.DISCUSSION: Nirsevimab has the potential to be cost-effective in England and Wales not only for use in high-risk infants.

KW - Cost-effectiveness analysis

KW - Economic model

KW - Monoclonal antibodies

KW - RSV

U2 - 10.1016/j.vaccine.2022.10.041

DO - 10.1016/j.vaccine.2022.10.041

M3 - Article

C2 - 36328884

SN - 0264-410X

VL - 40

SP - 7151

EP - 7157

JO - Vaccine

JF - Vaccine

IS - 49

ER -

Optimal Respiratory Syncytial Virus intervention programmes using Nirsevimab in England and Wales

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