Respiratory syncytial virus vaccination strategies for older Canadian adults: a cost-utility analysis.

Humans Cost-Benefit Analysis Respiratory Syncytial Virus Infections / prevention & control Canada Aged Respiratory Syncytial Virus Vaccines / economics Quality-Adjusted Life Years Middle Aged Female Male Age Factors Vaccination / economics Aged, 80 and over Immunization Programs / economics

Journal

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
ISSN: 1488-2329
Titre abrégé: CMAJ
Pays: Canada
ID NLM: 9711805

Informations de publication

Date de publication:
09 Sep 2024
Historique:
accepted: 11 06 2024
medline: 10 9 2024
pubmed: 10 9 2024
entrez: 9 9 2024
Statut: epublish

Résumé

Respiratory syncytial virus (RSV) vaccines could reduce disease burden and costs in older Canadian adults, but vaccination program cost-effectiveness is unknown. We evaluated the cost-effectiveness of different age cut-offs for RSV adult vaccination programs, with or without a focus on people with higher disease risk due to chronic medical conditions. We developed a static individual-based model of medically attended RSV disease to compare alternative age-, medical risk-, and age-plus medical risk-based vaccination policies. The model followed a multiage population of 100 000 people aged 50 years and older. Vaccine characteristics were based on RSV vaccines authorized in Canada as of May 2024, with vaccine protection assumed to last 2 years (or 3 years in scenario analyses). We calculated sequential incremental cost-effectiveness ratios in 2023 Canadian dollars per quality-adjusted life year (QALY) from the health-system and societal perspectives, discounted at 1.5%. Although all vaccination strategies averted medically attended RSV disease, universal age-based strategies were not an efficient use of resources compared with medical risk-based strategies. Vaccinating adults aged 70 years and older with 1 or more chronic medical condition was the optimal strategy for a cost-effectiveness threshold of $50 000 per QALY. Results were sensitive to assumptions about vaccine price, but medical risk-based approaches remained optimal compared with age-based strategies, even when vaccine prices were low. Findings were robust to a range of alternative assumptions. Vaccination programs for RSV in some groups of older Canadians with underlying medical conditions are likely cost-effective. These findings can inform the design of vaccination programs.

Sections du résumé

BACKGROUND BACKGROUND
Respiratory syncytial virus (RSV) vaccines could reduce disease burden and costs in older Canadian adults, but vaccination program cost-effectiveness is unknown. We evaluated the cost-effectiveness of different age cut-offs for RSV adult vaccination programs, with or without a focus on people with higher disease risk due to chronic medical conditions.
METHODS METHODS
We developed a static individual-based model of medically attended RSV disease to compare alternative age-, medical risk-, and age-plus medical risk-based vaccination policies. The model followed a multiage population of 100 000 people aged 50 years and older. Vaccine characteristics were based on RSV vaccines authorized in Canada as of May 2024, with vaccine protection assumed to last 2 years (or 3 years in scenario analyses). We calculated sequential incremental cost-effectiveness ratios in 2023 Canadian dollars per quality-adjusted life year (QALY) from the health-system and societal perspectives, discounted at 1.5%.
RESULTS RESULTS
Although all vaccination strategies averted medically attended RSV disease, universal age-based strategies were not an efficient use of resources compared with medical risk-based strategies. Vaccinating adults aged 70 years and older with 1 or more chronic medical condition was the optimal strategy for a cost-effectiveness threshold of $50 000 per QALY. Results were sensitive to assumptions about vaccine price, but medical risk-based approaches remained optimal compared with age-based strategies, even when vaccine prices were low. Findings were robust to a range of alternative assumptions.
INTERPRETATION CONCLUSIONS
Vaccination programs for RSV in some groups of older Canadians with underlying medical conditions are likely cost-effective. These findings can inform the design of vaccination programs.

Identifiants

DOI: 10.1503/cmaj.240452 PMID: 39251240
pubmed: 39251240
pii: 196/29/E989
doi: 10.1503/cmaj.240452
doi:

Substances chimiques

Respiratory Syncytial Virus Vaccines 0

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

E989-E1005

Informations de copyright

© 2024 CMA Impact Inc. or its licensors.

Déclaration de conflit d'intérêts

Competing interests:: Sarah Buchan declares funds from the Canadian Institutes of Health Research and SickKids to support work on the burden of respiratory syncytial virus (RSV) in older adults and young children. Dr. Buchan is a member of the National Advisory Committee on Immunization (NACI) RSV Working Group and liaison member to NACI for the Canadian Association for Immunization Research, Evaluation and Education. Nicholas Brousseau is a member of NACI and the Quebec Immunization Committee. No other competing interests were declared.

Auteurs

Ashleigh R Tuite (AR)

Centre for Immunization Programs (Tuite, Simmons, Rudd, Cernat, Gebretekle, Yeung, Killikelly, Siu, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Dalla Lana School of Public Health (Tuite, Simmons, Rudd, Buchan), University of Toronto, Toronto, Ont.; Health Policy PhD Program (Cernat), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Epidemiology and Public Health (Siu), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Health Protection (Buchan), Public Health Ontario, Toronto, Ont.; Direction des risques biologiques (Brousseau), Institut national de santé publique du Québec, Québec, Que. ashleigh.tuite@phac-aspc.gc.ca.

Alison E Simmons (AE)

Centre for Immunization Programs (Tuite, Simmons, Rudd, Cernat, Gebretekle, Yeung, Killikelly, Siu, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Dalla Lana School of Public Health (Tuite, Simmons, Rudd, Buchan), University of Toronto, Toronto, Ont.; Health Policy PhD Program (Cernat), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Epidemiology and Public Health (Siu), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Health Protection (Buchan), Public Health Ontario, Toronto, Ont.; Direction des risques biologiques (Brousseau), Institut national de santé publique du Québec, Québec, Que.

Monica Rudd (M)

Centre for Immunization Programs (Tuite, Simmons, Rudd, Cernat, Gebretekle, Yeung, Killikelly, Siu, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Dalla Lana School of Public Health (Tuite, Simmons, Rudd, Buchan), University of Toronto, Toronto, Ont.; Health Policy PhD Program (Cernat), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Epidemiology and Public Health (Siu), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Health Protection (Buchan), Public Health Ontario, Toronto, Ont.; Direction des risques biologiques (Brousseau), Institut national de santé publique du Québec, Québec, Que.

Alexandra Cernat (A)

Centre for Immunization Programs (Tuite, Simmons, Rudd, Cernat, Gebretekle, Yeung, Killikelly, Siu, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Dalla Lana School of Public Health (Tuite, Simmons, Rudd, Buchan), University of Toronto, Toronto, Ont.; Health Policy PhD Program (Cernat), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Epidemiology and Public Health (Siu), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Health Protection (Buchan), Public Health Ontario, Toronto, Ont.; Direction des risques biologiques (Brousseau), Institut national de santé publique du Québec, Québec, Que.

Gebremedhin B Gebretekle (GB)

Centre for Immunization Programs (Tuite, Simmons, Rudd, Cernat, Gebretekle, Yeung, Killikelly, Siu, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Dalla Lana School of Public Health (Tuite, Simmons, Rudd, Buchan), University of Toronto, Toronto, Ont.; Health Policy PhD Program (Cernat), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Epidemiology and Public Health (Siu), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Health Protection (Buchan), Public Health Ontario, Toronto, Ont.; Direction des risques biologiques (Brousseau), Institut national de santé publique du Québec, Québec, Que.

Man Wah Yeung (MW)

Centre for Immunization Programs (Tuite, Simmons, Rudd, Cernat, Gebretekle, Yeung, Killikelly, Siu, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Dalla Lana School of Public Health (Tuite, Simmons, Rudd, Buchan), University of Toronto, Toronto, Ont.; Health Policy PhD Program (Cernat), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Epidemiology and Public Health (Siu), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Health Protection (Buchan), Public Health Ontario, Toronto, Ont.; Direction des risques biologiques (Brousseau), Institut national de santé publique du Québec, Québec, Que.

April Killikelly (A)

Centre for Immunization Programs (Tuite, Simmons, Rudd, Cernat, Gebretekle, Yeung, Killikelly, Siu, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Dalla Lana School of Public Health (Tuite, Simmons, Rudd, Buchan), University of Toronto, Toronto, Ont.; Health Policy PhD Program (Cernat), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Epidemiology and Public Health (Siu), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Health Protection (Buchan), Public Health Ontario, Toronto, Ont.; Direction des risques biologiques (Brousseau), Institut national de santé publique du Québec, Québec, Que.

Winnie Siu (W)

Centre for Immunization Programs (Tuite, Simmons, Rudd, Cernat, Gebretekle, Yeung, Killikelly, Siu, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Dalla Lana School of Public Health (Tuite, Simmons, Rudd, Buchan), University of Toronto, Toronto, Ont.; Health Policy PhD Program (Cernat), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Epidemiology and Public Health (Siu), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Health Protection (Buchan), Public Health Ontario, Toronto, Ont.; Direction des risques biologiques (Brousseau), Institut national de santé publique du Québec, Québec, Que.

Sarah A Buchan (SA)

Centre for Immunization Programs (Tuite, Simmons, Rudd, Cernat, Gebretekle, Yeung, Killikelly, Siu, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Dalla Lana School of Public Health (Tuite, Simmons, Rudd, Buchan), University of Toronto, Toronto, Ont.; Health Policy PhD Program (Cernat), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Epidemiology and Public Health (Siu), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Health Protection (Buchan), Public Health Ontario, Toronto, Ont.; Direction des risques biologiques (Brousseau), Institut national de santé publique du Québec, Québec, Que.

Nicholas Brousseau (N)

Centre for Immunization Programs (Tuite, Simmons, Rudd, Cernat, Gebretekle, Yeung, Killikelly, Siu, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Dalla Lana School of Public Health (Tuite, Simmons, Rudd, Buchan), University of Toronto, Toronto, Ont.; Health Policy PhD Program (Cernat), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Epidemiology and Public Health (Siu), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Health Protection (Buchan), Public Health Ontario, Toronto, Ont.; Direction des risques biologiques (Brousseau), Institut national de santé publique du Québec, Québec, Que.

Matthew Tunis (M)

Centre for Immunization Programs (Tuite, Simmons, Rudd, Cernat, Gebretekle, Yeung, Killikelly, Siu, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Dalla Lana School of Public Health (Tuite, Simmons, Rudd, Buchan), University of Toronto, Toronto, Ont.; Health Policy PhD Program (Cernat), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Epidemiology and Public Health (Siu), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Health Protection (Buchan), Public Health Ontario, Toronto, Ont.; Direction des risques biologiques (Brousseau), Institut national de santé publique du Québec, Québec, Que.

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