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

IF 9.4 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
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: 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: 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: 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: 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.

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)疫苗可减少加拿大老年人的疾病负担和成本,但疫苗接种计划的成本效益尚不清楚。我们评估了 RSV 成人疫苗接种计划不同年龄分界线的成本效益,无论是否关注因慢性病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 疾病医疗模型,以比较基于年龄、医疗风险和年龄加医疗风险的替代疫苗接种政策。该模型以 10 万名 50 岁及以上的多年龄段人群为研究对象。疫苗特征基于截至 2024 年 5 月加拿大批准的 RSV 疫苗,假定疫苗保护期为 2 年(情景分析中为 3 年)。我们从医疗系统和社会角度计算了2023年每质量调整生命年(QALY)的递增成本效益比,折现率为1.5%:结果:尽管所有疫苗接种策略都能避免因医疗导致的 RSV 疾病,但与基于医疗风险的策略相比,基于年龄的通用策略并不能有效利用资源。在每 QALY 的成本效益阈值为 50 000 美元时,为 70 岁及以上患有一种或多种慢性疾病的成年人接种疫苗是最佳策略。结果对疫苗价格的假设很敏感,但与基于年龄的策略相比,基于医疗风险的策略仍然是最佳策略,即使疫苗价格很低。研究结果对一系列其他假设都是稳健的:对某些患有潜在疾病的加拿大老年人群体实施 RSV 疫苗接种计划可能具有成本效益。这些发现可为疫苗接种计划的设计提供参考。
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来源期刊
Canadian Medical Association journal
Canadian Medical Association journal 医学-医学:内科
CiteScore
8.30
自引率
4.10%
发文量
481
审稿时长
4-8 weeks
期刊介绍: CMAJ (Canadian Medical Association Journal) is a peer-reviewed general medical journal renowned for publishing original research, commentaries, analyses, reviews, clinical practice updates, and editorials. Led by Editor-in-Chief Dr. Kirsten Patrick, it has a significant impact on healthcare in Canada and globally, with a 2022 impact factor of 17.4. Its mission is to promote knowledge vital for the health of Canadians and the global community, guided by values of service, evidence, and integrity. The journal's vision emphasizes the importance of the best evidence, practice, and health outcomes. CMAJ covers a broad range of topics, focusing on contributing to the evidence base, influencing clinical practice, and raising awareness of pressing health issues among policymakers and the public. Since 2020, with the appointment of a Lead of Patient Involvement, CMAJ is committed to integrating patients into its governance and operations, encouraging their content submissions.
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