Influential drivers of the cost-effectiveness of respiratory syncytial virus vaccination in European older adults: a multi-country analysis
Abstract Background We aimed to identify influential drivers of the cost-effectiveness of older adult respiratory syncytial virus (RSV) vaccination in Denmark, Finland, the Netherlands and Valencia-Spain. Methods A static multi-cohort model was parameterised using country- and age-specific hospitali...
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2025-03-01
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| Online Access: | https://doi.org/10.1186/s12916-025-03970-x |
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| author | Xiao Li Lander Willem Caroline Klint Johannesen Arantxa Urchueguía-Fornes Toni Lehtonen Richard Osei-Yeboah Heini Salo Alejandro Orrico-Sánchez Javier Díez-Domingo Mark Jit for PROMISE investigators Joke Bilcke Harish Nair Philippe Beutels |
| author_facet | Xiao Li Lander Willem Caroline Klint Johannesen Arantxa Urchueguía-Fornes Toni Lehtonen Richard Osei-Yeboah Heini Salo Alejandro Orrico-Sánchez Javier Díez-Domingo Mark Jit for PROMISE investigators Joke Bilcke Harish Nair Philippe Beutels |
| author_sort | Xiao Li |
| collection | DOAJ |
| description | Abstract Background We aimed to identify influential drivers of the cost-effectiveness of older adult respiratory syncytial virus (RSV) vaccination in Denmark, Finland, the Netherlands and Valencia-Spain. Methods A static multi-cohort model was parameterised using country- and age-specific hospitalisations using three approaches: (A) the International Classification of Diseases (ICD)-coded hospitalisations, (B) laboratory RSV-confirmed hospitalisations and (C) time-series modelling (TSM). Plausible hypothetical RSV vaccine characteristics were derived from two protein subunit vaccines for adults aged ≥60 years. A full incremental analysis was conducted by comparing three RSV vaccination strategies: (1) in adults aged ≥60 years (“60y+”); (2) in adults aged ≥65 years (“65y+”); (3) in adults aged ≥75 years (“75y+”) to “no intervention” and to each other. Both costs and quality-adjusted life-years (QALYs) were discounted at country-specific discount rates and the analysis was conducted from both the healthcare payers’ and societal perspectives. Value of information, probabilistic sensitivity and scenario analyses identified influential drivers. Results Besides vaccine price, the hospitalisation estimates were most influential: (A) Using adjusted RSV-ICD-coded hospitalisations at a vaccine price of €150 per dose, no intervention was cost-effective up to willingness-to-pay (WTP) values of €150,000 per QALY gained in Denmark and the Netherlands, and up to €124,000 per QALY gained in Finland. (B) Using the adjusted RSV-confirmed dataset, the findings were consistent in Denmark and comparable in Finland. In Spain-Valencia, the 75y+ strategy became cost-effective at WTP >€55,000. (C) Using TSM-based estimates, the 75y+ strategy was cost-effective at WTP >€45,000, >€101,000, >€41,000 and >€114,000 in Denmark, Finland, the Netherlands and Spain-Valencia, respectively. Sensitivity analyses showed that the (in-hospital) case fatality ratio and the specification of its age dependency were both influential. Duration of protection was found more influential than a variety of plausible waning patterns over the duration of protection. Conclusions Data gaps and uncertainties on the RSV-related burden in older adults persist and influence the cost-effectiveness of RSV vaccination. More refined age- and country-specific data on the RSV attributable burden are crucial to aid decision making. |
| format | Article |
| id | doaj-art-6951349faf804878ac8efc2ffc8722ec |
| institution | DOAJ |
| issn | 1741-7015 |
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| publishDate | 2025-03-01 |
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| spelling | doaj-art-6951349faf804878ac8efc2ffc8722ec2025-08-20T03:05:13ZengBMCBMC Medicine1741-70152025-03-0123111710.1186/s12916-025-03970-xInfluential drivers of the cost-effectiveness of respiratory syncytial virus vaccination in European older adults: a multi-country analysisXiao Li0Lander Willem1Caroline Klint Johannesen2Arantxa Urchueguía-Fornes3Toni Lehtonen4Richard Osei-Yeboah5Heini Salo6Alejandro Orrico-Sánchez7Javier Díez-Domingo8Mark Jit9for PROMISE investigatorsJoke Bilcke10Harish Nair11Philippe Beutels12Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, University of AntwerpCentre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, University of AntwerpThe Department of Clinical Research, North Zealand HospitalVaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, FISABIO-Public-HealthFinnish Institute for Health and WelfareCentre for Global Health, The University of EdinburghFinnish Institute for Health and WelfareVaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, FISABIO-Public-HealthVaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, FISABIO-Public-HealthDepartment of Infectious Disease Epidemiology & Dynamics, London School of Hygiene & Tropical MedicineCentre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, University of AntwerpCentre for Global Health, The University of EdinburghCentre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, University of AntwerpAbstract Background We aimed to identify influential drivers of the cost-effectiveness of older adult respiratory syncytial virus (RSV) vaccination in Denmark, Finland, the Netherlands and Valencia-Spain. Methods A static multi-cohort model was parameterised using country- and age-specific hospitalisations using three approaches: (A) the International Classification of Diseases (ICD)-coded hospitalisations, (B) laboratory RSV-confirmed hospitalisations and (C) time-series modelling (TSM). Plausible hypothetical RSV vaccine characteristics were derived from two protein subunit vaccines for adults aged ≥60 years. A full incremental analysis was conducted by comparing three RSV vaccination strategies: (1) in adults aged ≥60 years (“60y+”); (2) in adults aged ≥65 years (“65y+”); (3) in adults aged ≥75 years (“75y+”) to “no intervention” and to each other. Both costs and quality-adjusted life-years (QALYs) were discounted at country-specific discount rates and the analysis was conducted from both the healthcare payers’ and societal perspectives. Value of information, probabilistic sensitivity and scenario analyses identified influential drivers. Results Besides vaccine price, the hospitalisation estimates were most influential: (A) Using adjusted RSV-ICD-coded hospitalisations at a vaccine price of €150 per dose, no intervention was cost-effective up to willingness-to-pay (WTP) values of €150,000 per QALY gained in Denmark and the Netherlands, and up to €124,000 per QALY gained in Finland. (B) Using the adjusted RSV-confirmed dataset, the findings were consistent in Denmark and comparable in Finland. In Spain-Valencia, the 75y+ strategy became cost-effective at WTP >€55,000. (C) Using TSM-based estimates, the 75y+ strategy was cost-effective at WTP >€45,000, >€101,000, >€41,000 and >€114,000 in Denmark, Finland, the Netherlands and Spain-Valencia, respectively. Sensitivity analyses showed that the (in-hospital) case fatality ratio and the specification of its age dependency were both influential. Duration of protection was found more influential than a variety of plausible waning patterns over the duration of protection. Conclusions Data gaps and uncertainties on the RSV-related burden in older adults persist and influence the cost-effectiveness of RSV vaccination. More refined age- and country-specific data on the RSV attributable burden are crucial to aid decision making.https://doi.org/10.1186/s12916-025-03970-xRSVRespiratoryVaccinationPolicyAgeing populationEconomic evaluation |
| spellingShingle | Xiao Li Lander Willem Caroline Klint Johannesen Arantxa Urchueguía-Fornes Toni Lehtonen Richard Osei-Yeboah Heini Salo Alejandro Orrico-Sánchez Javier Díez-Domingo Mark Jit for PROMISE investigators Joke Bilcke Harish Nair Philippe Beutels Influential drivers of the cost-effectiveness of respiratory syncytial virus vaccination in European older adults: a multi-country analysis BMC Medicine RSV Respiratory Vaccination Policy Ageing population Economic evaluation |
| title | Influential drivers of the cost-effectiveness of respiratory syncytial virus vaccination in European older adults: a multi-country analysis |
| title_full | Influential drivers of the cost-effectiveness of respiratory syncytial virus vaccination in European older adults: a multi-country analysis |
| title_fullStr | Influential drivers of the cost-effectiveness of respiratory syncytial virus vaccination in European older adults: a multi-country analysis |
| title_full_unstemmed | Influential drivers of the cost-effectiveness of respiratory syncytial virus vaccination in European older adults: a multi-country analysis |
| title_short | Influential drivers of the cost-effectiveness of respiratory syncytial virus vaccination in European older adults: a multi-country analysis |
| title_sort | influential drivers of the cost effectiveness of respiratory syncytial virus vaccination in european older adults a multi country analysis |
| topic | RSV Respiratory Vaccination Policy Ageing population Economic evaluation |
| url | https://doi.org/10.1186/s12916-025-03970-x |
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