Burden of paediatric respiratory syncytial virus disease and potential effect of different immunisation strategies: a modelling and cost-effectiveness analysis for England
Background: Vaccines and prophylactic antibodies against respiratory syncytial virus (RSV) are in development and likely to be available in the next 5–10 years. The most efficient way to use these products when they become available is an important consideration for public health decision makers. Me...
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doaj-5589de0465ef42e886d1cb8d00393c152020-11-25T02:40:23ZengElsevierThe Lancet Public Health2468-26672017-08-0128e367e37410.1016/S2468-2667(17)30103-2Burden of paediatric respiratory syncytial virus disease and potential effect of different immunisation strategies: a modelling and cost-effectiveness analysis for EnglandDr Deborah Cromer, PhD0Albert Jan van Hoek, PhD1Anthony T Newall, PhD2Andrew J Pollard, FMedSci3Mark Jit, PhD4Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW, AustraliaDepartment of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UKSchool of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, AustraliaOxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UKDepartment of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UKBackground: Vaccines and prophylactic antibodies against respiratory syncytial virus (RSV) are in development and likely to be available in the next 5–10 years. The most efficient way to use these products when they become available is an important consideration for public health decision makers. Methods: We performed a multivariate regression analysis to estimate the burden of RSV in children younger than 5 years in England (UK), a representative high-income temperate country, and used these results to assess the potential effect of different RSV immunisation strategies (targeting vaccination for infants, or pregnant women, or prophylactic antibodies for neonates). We did a cost-effectiveness analysis for these strategies, implemented either separately or concurrently, and assessed the effect of restricting vaccination to certain months of the year. Findings: We estimated that RSV is responsible for 12 primary care consultations (95% CI 11·9–12·1) and 0·9 admissions to hospital annually per 100 children younger than 5 years (95% CI 0·89–0·90), with the major burden occurring in infants younger than 6 months. The most cost-effective strategy was to selectively immunise all children born before the start of the RSV season (maximum price of £220 [95% uncertainty interval (UI) 208–232] per vaccine, for an incremental cost-effectiveness ratio of £20 000 per quality-adjusted life-year). The maximum price per fully protected person that should be paid for the infant, newborn, and maternal strategies without seasonal restrictions was £192 (95% UI 168–219), £81 (76–86), and £54 (51–57), respectively. Interpretation: Nearly double the number of primary care consultations, and nearly five times the number of admissions to hospital occurred with RSV compared with influenza. RSV vaccine and antibody strategies are likely to be cost-effective if they can be priced below around £200 per fully protected person. A seasonal vaccination strategy is likely to provide the most direct benefits. Herd effects might render a year-round infant vaccination strategy more appealing, although it is currently unclear whether such a programme would induce herd effects. Funding: UK National Institute for Health Research.http://www.sciencedirect.com/science/article/pii/S2468266717301032 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Dr Deborah Cromer, PhD Albert Jan van Hoek, PhD Anthony T Newall, PhD Andrew J Pollard, FMedSci Mark Jit, PhD |
spellingShingle |
Dr Deborah Cromer, PhD Albert Jan van Hoek, PhD Anthony T Newall, PhD Andrew J Pollard, FMedSci Mark Jit, PhD Burden of paediatric respiratory syncytial virus disease and potential effect of different immunisation strategies: a modelling and cost-effectiveness analysis for England The Lancet Public Health |
author_facet |
Dr Deborah Cromer, PhD Albert Jan van Hoek, PhD Anthony T Newall, PhD Andrew J Pollard, FMedSci Mark Jit, PhD |
author_sort |
Dr Deborah Cromer, PhD |
title |
Burden of paediatric respiratory syncytial virus disease and potential effect of different immunisation strategies: a modelling and cost-effectiveness analysis for England |
title_short |
Burden of paediatric respiratory syncytial virus disease and potential effect of different immunisation strategies: a modelling and cost-effectiveness analysis for England |
title_full |
Burden of paediatric respiratory syncytial virus disease and potential effect of different immunisation strategies: a modelling and cost-effectiveness analysis for England |
title_fullStr |
Burden of paediatric respiratory syncytial virus disease and potential effect of different immunisation strategies: a modelling and cost-effectiveness analysis for England |
title_full_unstemmed |
Burden of paediatric respiratory syncytial virus disease and potential effect of different immunisation strategies: a modelling and cost-effectiveness analysis for England |
title_sort |
burden of paediatric respiratory syncytial virus disease and potential effect of different immunisation strategies: a modelling and cost-effectiveness analysis for england |
publisher |
Elsevier |
series |
The Lancet Public Health |
issn |
2468-2667 |
publishDate |
2017-08-01 |
description |
Background: Vaccines and prophylactic antibodies against respiratory syncytial virus (RSV) are in development and likely to be available in the next 5–10 years. The most efficient way to use these products when they become available is an important consideration for public health decision makers.
Methods: We performed a multivariate regression analysis to estimate the burden of RSV in children younger than 5 years in England (UK), a representative high-income temperate country, and used these results to assess the potential effect of different RSV immunisation strategies (targeting vaccination for infants, or pregnant women, or prophylactic antibodies for neonates). We did a cost-effectiveness analysis for these strategies, implemented either separately or concurrently, and assessed the effect of restricting vaccination to certain months of the year.
Findings: We estimated that RSV is responsible for 12 primary care consultations (95% CI 11·9–12·1) and 0·9 admissions to hospital annually per 100 children younger than 5 years (95% CI 0·89–0·90), with the major burden occurring in infants younger than 6 months. The most cost-effective strategy was to selectively immunise all children born before the start of the RSV season (maximum price of £220 [95% uncertainty interval (UI) 208–232] per vaccine, for an incremental cost-effectiveness ratio of £20 000 per quality-adjusted life-year). The maximum price per fully protected person that should be paid for the infant, newborn, and maternal strategies without seasonal restrictions was £192 (95% UI 168–219), £81 (76–86), and £54 (51–57), respectively.
Interpretation: Nearly double the number of primary care consultations, and nearly five times the number of admissions to hospital occurred with RSV compared with influenza. RSV vaccine and antibody strategies are likely to be cost-effective if they can be priced below around £200 per fully protected person. A seasonal vaccination strategy is likely to provide the most direct benefits. Herd effects might render a year-round infant vaccination strategy more appealing, although it is currently unclear whether such a programme would induce herd effects.
Funding: UK National Institute for Health Research. |
url |
http://www.sciencedirect.com/science/article/pii/S2468266717301032 |
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