Cost-Effectiveness of Maternal RSVpreF Vaccination Compared with Newborn Nirsevimab RSV Prophylaxis or No RSV Prophylaxis in Switzerland

RSVpreF is a vaccine that immunises against respiratory syncytial virus (RSV), a seasonal respiratory virus, that can lead to lower respiratory tract infections. In Switzerland, RSVpreF is indicated for the passive protection of infants against RSV following maternal immunisation. The Swiss Federal Office of Public Health commissioned a health technology assessment (HTA) of RSVpreF for maternal vaccination, evaluating the clinical and cost effectiveness of the vaccine compared with nirsevimab (administered directly to newborns and infants) or no RSV prophylaxis. This study reports the cost-effectiveness model developed for the Swiss HTA. The model used a Markov model structure, a 1-year time horizon, a one-month cycle length, a Swiss healthcare payers' perspective, and a 3% discount rate for costs and health benefits. Health states included no RSV infection, RSV infection leading to hospitalisation, primary care visits or emergency department visits, post-RSV infection, and death. MATISSE informed RSVpreF efficacy, and MELODY and HARMONIE informed nirsevimab efficacy. Health outcomes were expressed as quality-adjusted life years (QALYs). Probabilistic and deterministic sensitivity analyses were undertaken to explore the impact of parameter uncertainty on the model results. When compared with nirsevimab, RSVpreF reduces total costs (CHF −9,878,738) and QALYs (−18.4), with an incremental cost-effectiveness ratio (ICER) of 536,008 per QALY ( N = 38,844). Compared with no RSV prophylaxis, RSVpreF increases total costs (CHF +470,441) and QALYs (+27.1), with an ICER of 17,377 per QALY ( N = 38,844). RSVpreF is highly likely to be cost-effective versus both comparators at a range of plausible threshold values. The results of the model contributed to guidance updates in Switzerland, with RSVpreF now reimbursed by mandatory health insurance.