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

Ashleigh R Tuite, Alison E Simmons, Monica Rudd, Alexandra Cernat, Gebremedhin B Gebretekle, Man Wah Yeung, April Killikelly, Winnie Siu, Sarah A Buchan, Nicholas Brousseau, Matthew Tunis
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Abstract

Background: Vaccines against respiratory syncytial virus (RSV) have the potential to reduce disease burden and costs in Canadians, but the cost-effectiveness of RSV vaccination programs for older adults is unknown. We evaluated the cost-effectiveness of different adult age cutoffs for RSV vaccination programs, with or without a focus on people with higher disease risk due to chronic medical conditions (CMCs). Methods: We developed a static individual-based model of medically-attended RSV disease to evaluate the cost-utility of alternate age-, medical risk-, and age- plus medical risk-based vaccination policies. The model followed a multi-age cohort of 100,000 people aged 50 years and older over a three-year period. Vaccine characteristics were based on RSV vaccines authorized in Canada as of March 2024. We calculated incremental cost-effectiveness ratios (ICERs) in 2023 Canadian dollars per quality-adjust life year (QALY) from the health system and societal perspectives, discounted at 1.5%. Results: Although all vaccination strategies averted medically-attended RSV disease, strategies focused on adults with CMCs were more likely to be cost-effective than age-based strategies. A program focused on vaccinating adults aged 70 years and older with one or more CMCs was optimal for a cost-effectiveness threshold of $50,000 per QALY. Results were sensitive to assumptions about vaccine price, but approaches based on medical risk remained optimal compared to age-based strategies even when vaccine prices were low. Findings were robust to a range of alternate assumptions. Interpretation: Based on available data, RSV vaccination programs in some groups of older Canadians with underlying medical conditions are expected to be cost-effective.
加拿大老年人呼吸道合胞病毒疫苗接种策略:成本效用分析
背景:呼吸道合胞病毒(RSV)疫苗有可能减轻加拿大人的疾病负担并降低成本,但针对老年人的 RSV 疫苗接种计划的成本效益尚不清楚。我们评估了 RSV 疫苗接种计划中不同成人年龄界限的成本效益,无论是否侧重于因慢性病(CMC)而患病风险较高的人群。方法:我们建立了一个基于个人的静态 RSV 疾病就诊模型,以评估基于年龄、医疗风险和年龄加医疗风险的交替疫苗接种政策的成本效益。该模型对 10 万名 50 岁及以上的多年龄段人群进行了为期三年的跟踪调查。疫苗特征基于截至 2024 年 3 月加拿大批准使用的 RSV 疫苗。我们从卫生系统和社会角度计算了 2023 年每质量调整生命年 (QALY) 的增量成本效益比 (ICER),折现率为 1.5%。研究结果尽管所有的疫苗接种策略都能避免因医疗原因导致的 RSV 疾病,但与基于年龄的接种策略相比,以患有 CMC 的成人为重点的接种策略更有可能实现成本效益。如果成本效益阈值为每 QALY 50,000 美元,那么重点为 70 岁及以上患有一种或多种 CMC 的成人接种疫苗的计划是最佳的。结果对疫苗价格的假设很敏感,但与基于年龄的策略相比,即使疫苗价格低廉,基于医疗风险的方法仍然是最佳的。研究结果对一系列其他假设都是稳健的。解释:根据现有数据,针对某些患有潜在疾病的加拿大老年人群体的 RSV 疫苗接种计划预计具有成本效益。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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