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. 2023 Oct 17;11(10):1605.
doi: 10.3390/vaccines11101605.

Comparative Cost-Effectiveness Analysis of Respiratory Syncytial Virus Vaccines for Older Adults in Hong Kong

Yingcheng Wang  1 , Ginenus Fekadu  1 , Joyce H S You  1
Affiliations

Comparative Cost-Effectiveness Analysis of Respiratory Syncytial Virus Vaccines for Older Adults in Hong Kong

Yingcheng Wang et al. Vaccines (Basel). .

Abstract

Two respiratory syncytial virus (RSV) vaccines (AREXVY® and ABRYSVO®) were recently approved for older adults in the US. This study aimed to evaluate the cost-effectiveness of AREXVY® and ABRYSVO® from the Hong Kong public healthcare provider's perspective. A two-year decision-analytical model was developed to examine the outcomes of a single RSV vaccination (AREXVY® or ABRYSVO®) compared to no vaccination. Primary outcomes included RSV-related health outcomes, direct medical costs, quality-adjusted life-year (QALY) loss, and incremental cost per QALY (ICER). RSV vaccines are not yet marketed in Hong Kong, base-case analysis, therefore, benchmarked US RSV vaccine prices at 4 levels (25%, 50%, 75%, 100%). AREXVY® and ABRYSVO® (versus no vaccination) gained 0.000568 QALY and 0.000647 QALY, respectively. ICERs of ABRYSVO® (26,209 USD/QALY) and AREXVY® (47,485 USD/QALY) were lower than the willingness-to-pay threshold (49,594 USD/QALY) at 25% US vaccine price. The RSV attack rate was a common influential factor at all vaccine price levels. The probabilities of AREXVY® and ABRYSVO® to be most cost-effective were 0.10% and 97.68%, respectively, at 25% US vaccine price. Single vaccination of ABRYSVO® or AREXVY® for older adults appears to gain QALYs over 2 years in Hong Kong. The cost-effectiveness of AREXVY® and ABRYSVO® is subject to vaccine price and RSV attack rate.

Keywords: cost-effectiveness analysis; older adults; respiratory infection; respiratory syncytial virus; vaccination.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Simplified decision-analytical model for RSV vaccination in Hong Kong older adults (age ≥60 years). (A) year one post-vaccination, (B) year two post-vaccination. RSV: respiratory syncytial virus; LRTD: lower respiratory tract illness; ARI: acute respiratory infection. Square symbol: decision node, three branches on the right side of the decision node represent three strategies examined by the model; Circular symbol: chance node, represents the events characterized by event-specific probabilities; Triangle symbol: terminal node, represents the end of the model pathway.
Figure 2
Figure 2
(a–d) Tornado diagrams of the variation of the ICER of the ABRYSVO® group (versus no vaccination) against the top five influential parameters identified in one-way sensitivity analysis at (a) 25%, (b) 50%, (c) 75%, and (d) 100% US vaccine price levels. Ranges of variation in ICERs at 25% (a), 75% (c), and 100% (d) US vaccine price levels did not cross the WTP threshold (robust to the variation of model inputs). At 50% US vaccine price level (b), ICER < WTP threshold at variation of multiplier for under-detection of RSV by rapid antigen assays (base-case value 3.47) exceeded 4.38 or the RSV attack rate (base-case value 1.62%) exceeded 4.20%. US vaccine price: USD 200 for ABRYSVO®; RSV: respiratory syncytial virus; VE: vaccine efficacy; ARI: acute respiratory infection; LRTD: lower respiratory tract illness; ICER: incremental cost-effectiveness ratio; WTP: willingness-to-pay = 49,594 USD/QALY gained.
Figure 3
Figure 3
(a–d) Tornado diagrams of the variation of the ICER of the AREXVY® group (versus no vaccination) against the top five influential parameters identified in one-way sensitivity analysis at (a) 25%, (b) 50%, (c) 75%, and (d) 100% US vaccine price levels. At 25% US vaccine price level (a), ICER > WTP threshold at variation of 14 influential factors (threshold values listed in Supplementary Materials Table S2). Ranges of variation in ICERs at the 50% (b), 75% (c), and 100% (d) US vaccine price levels did not cross the WTP threshold (robust to the variation of model inputs). US vaccine price: USD 270 for AREXVY®; RSV: respiratory syncytial virus; VE: vaccine efficacy; ARI: acute respiratory infection; LRTD: lower respiratory tract illness; ICER: incremental cost-effectiveness ratio; WTP: willingness-to-pay = 49,594 USD/QALY gained.
Figure 4
Figure 4
(a–d) Scatter plots of incremental cost and QALY gained by the vaccination strategies versus no vaccination in 10,000 Monte Carlo simulations at (a) 25%, (b) 50%, (c) 75%, and (d) 100% US vaccine price levels. ICERs of the ABRYSVO® group (versus no vaccination) were below the WTP threshold in 97.66% (a), 15.77% (b), 0.07% (c), and 0% (d) of 10,000 simulations. ICERs of the AREXVY® group (versus no vaccination) were below the WTP threshold in 53% (a), 0.05% (b), 0% (c), and 0% (d) of 10,000 simulations. US vaccine price: USD 270 for AREXVY® and USD 200 for ABRYSVO®; QALY: quality-adjusted life year; WTP: willingness-to-pay; WTP = 49,594 USD/QALY gained.
Figure 5
Figure 5
Variation in the probability of each vaccination strategy to be cost-effective against willingness-to-pay at (a) 25%, (b) 50%, (c) 75%, and (d) 100% US vaccine price levels. At the WTP threshold of 49,594 USD/QALY gained, probabilities of ABRYSVO® to be the most cost-effective were 97.68% (a), 16.65% (b), 0.08% (c), and 0% (d). Probabilities of AREXVY® to be the most cost-effective were 0.10% (a), 0% (b), 0% (c), and 0% (d). US vaccine price: USD 270 for AREXVY® and USD 200 for ABRYSVO®; QALY: quality-adjusted life year; WTP: willingness-to-pay; WTP = 49,594 USD/QALY gained.
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