Written by Kimiko Dunbar
Spoon Feed
Nirsevimab for RSV prophylaxis is an expensive but likely cost-effective intervention, particularly for infants in their first RSV season.
Is the juice worth the squeeze?
According to the CDC, the new RSV prophylaxis is currently the most expensive “standard” pediatric immunization on the market. Still, the estimated disease and economic burden of RSV infection are high. The cost-effectiveness analysis conducted in this study evaluated the economic impact of nirsevimab for preventing RSV in U.S. infants. Using a decision-analytic model, researchers estimated that administering nirsevimab to 50% of the birth cohort could prevent 107,253 outpatient visits, 38,204 emergency visits, and 14,341 hospitalizations annually, at a cost of $153,517 per quality-adjusted life year (QALY) saved. The study concluded that nirsevimab is potentially cost-effective, particularly in high-risk infants, given RSV’s substantial morbidity and economic burden. QALY could be much lower if the price per dose is decreased, efficacy is higher, or URIs are also prevented. This was highly theoretical, making many assumptions, with simulation of short- and long-term impacts on infants with and without immunizations. Of note, ACIP (Advisory Committee on Immunization Practices) incorporated these findings into their recommendations for infants. For perspective, the cost-effectiveness of the flu vaccine is generally less than $95,000 per QALY (lower numbers are better).
How will this change my practice?
As excited as I am about the opportunity for widespread RSV prophylaxis, I’m surprised by just how expensive it is. When it comes to vaccine/antibody counseling, I’m strictly adherent to the AAP/CDC recommendations, and this study won’t change that. There’s more to consider than just cost, but I now understand the need to limit it to children in their first RSV season or those with high risk of severe disease in their second season.
Sources
Cost-Effectiveness of Nirsevimab for Respiratory Syncytial Virus in Infants and Young Children. Pediatrics. 2024 Dec 1;154(6):e2024066461. doi: 10.1542/peds.2024-066461. PMID: 39582316
