Optimizing next-generation RSV prevention in Mali: A cost-effectiveness analysis of pediatric vaccination, maternal vaccination, and extended half-life monoclonal antibody immunoprophylaxis.

Respiratory syncytial virus (RSV) is the most common cause of early childhood lower respiratory tract infection (LRTI) in low- and middle-income countries (LMICs). Maternal vaccines, birth-dose extended half-life monoclonal antibodies (mAbs), and pediatric vaccines are under development for prevention of respiratory syncytial virus (RSV) lower respiratory tract infection (LRTI) in young children. We analyzed the health and economic impact of RSV interventions used alone or in combinations in Mali. We modeled age-specific and season-specific risks of RSV LRTI in children through three years, using WHO Preferred Product Characteristics and data generated in Mali. Health outcomes included RSV LRTI cases, hospitalizations, deaths, and disability-adjusted life-years (DALYs). We identified the optimal combination of products across a range of scenarios. We found that mAb delivered at birth could avert 878 DALYs per birth cohort at an incremental cost-effectiveness ratio (ICER) of $597 per DALY averted compared to no intervention if the product were available at $1 per dose. Combining mAb with pediatric vaccine administered at 10/14 weeks, 1947 DALYs would be prevented. The ICER of this combination strategy is $1514 per DALY averted compared to mAb alone. Incorporating parameter uncertainty, mAb alone is likely to be optimal from the societal perspective at efficacy against RSV LRTI above 66%. The optimal strategy was sensitive to economic considerations, including product prices and willingness-to-pay for DALYs. For example, the combination of mAb and pediatric vaccine would be optimal from the government perspective at a willingness-to-pay above $775 per DALY. Maternal vaccine alone or in combination with other interventions was never the optimal strategy, even for high vaccine efficacy. The same was true for pediatric vaccine administered at 6/7 months. At prices comparable to existing vaccine products, extended half-life RSV mAbs would be impactful and efficient components of prevention strategies in LMICs such as Mali.

Informations de copyright

Copyright: © 2023 Laufer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Déclaration de conflit d'intérêts

I have read the journal’s policy and the authors of this manuscript have the following competing interests: • Rachel S. Laufer reports no interests. • Ranju Baral reports that her institution has received research grants from the Bill and Melinda Gates Foundation. • Andrea G. Buchwald reports no interests. • James D. Campbell reports that his institution has received research grants from GlaxoSmithKline and Pfizer. • Flanon Coulibaly reports no interests. • Fatoumata Diallo reports no interests. • Moussa Doumbia reports no interests. • Amanda J. Driscoll reports no interests. • Alison P. Galvani reports no interests. • Adama M. Keita reports no interests. • Kathleen M. Neuzil reports that her institution has received research grants from GlaxoSmithKline, Pfizer, PATH, and National Institutes of Health for vaccine research. She is a member of SAGE. • Clint Pecenka reports that his institution has received research grants from the Bill and Melinda Gates Foundation. • Samba Sow reports no interests. • Justin R. Ortiz reports grants to his institution from National Science Foundation, Bill & Melinda Gates Foundation, Pfizer, National Institutes of Health, and World Health Organization outside the submitted work. • Meagan C. Fitzpatrick reports personal fees from Sanofi Pasteur, outside the submitted work.