Background: With a suite of promising new RSV prophylactics on the horizon, including long-acting monoclonal antibodies and new vaccines, it is likely that one or more of these will replace the current monoclonal Palivizumab programme. However, choosing the optimal intervention programme will require balancing the costs of the programmes with the health benefits accrued. Methods: To compare the next generation of RSV prophylactics, we integrated a novel transmission model with an economic analysis. We estimated key epidemiological parameters by calibrating the model to 7 years of historical epidemiological data using a Bayesian approach. We determined the cost-effective and affordable maximum purchase price for a comprehensive suite of intervention programmes. Findings: Our transmission model suggests that maternal protection of infants is seasonal, with 38–62% of infants born with protection against RSV. Our economic analysis found that to cost-effectively and affordably replace the current monoclonal antibody Palivizumab programme with long-acting monoclonal antibodies, the purchase price per dose would have to be less than around £4350 but dropping to £200 for vaccinated heightened risk infants or £90 for all infants. A seasonal maternal vaccine would have to be priced less than £85 to be cost-effective and affordable. While vaccinating pre-school and school-age children is likely not cost-effective relative to elderly vaccination programmes, vaccinating the elderly is not likely to be affordable. Conversely, vaccinating infants at 2 months seasonally would be cost-effective and affordable if priced less than £80. Conclusions: In a setting with seasonal RSV epidemiology, maternal protection conferred to newborns is also seasonal, an assumption not previously incorporated in transmission models of RSV. For a country with seasonal RSV dynamics like England, seasonal programmes rather than year-round intervention programmes are always optimal.
Bibliographical noteFunding Information:
MB: The MRC Centre for Global Infectious Disease Analysis (grant MR/R015600/1) and the UK National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Modelling Methodology (Imperial College London) and Immunisation (London School of Hygiene and Tropical Medicine) in partnership with Public Health England (PHE) (grant HPRU-2012–10080) for funding. The views expressed are those of the authors and not necessarily those of the MRC, the UK National Health Service, the UK National Institute for Health Research, the UK Medical Research Council, the UK Department of Health, or Public Health England.
© 2020, The Author(s).
Copyright 2020 Elsevier B.V., All rights reserved.
- Maternal vaccination
- Monoclonal antibodies
- Respiratory syncytial virus
- Transmission model