Evaluating the next generation of RSV intervention strategies: a mathematical modelling study and cost-effectiveness ana
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RESEARCH ARTICLE
Open Access
Evaluating the next generation of RSV intervention strategies: a mathematical modelling study and cost-effectiveness analysis David Hodgson1,2,3,4* , Richard Pebody5, Jasmina Panovska-Griffiths1,2,6†, Marc Baguelin4,7,8† and Katherine E. Atkins7,9†
Abstract 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. Keywords: Respiratory syncytial virus, Transmission model, Maternal vaccination, Monoclonal antibodies
* Correspondence: [email protected] † Jasmina Panovska-Griffiths, Marc Baguelin and Katherine E. Atkins contributed equally to this work. 1 Centre for Mathematics, Physics and Engineering in the Life Sciences and Experimental Biology, University College London, London, UK 2 Department of Mathematics, University College London, London, UK Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author
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