Cost-effectiveness of monoclonal antibody and maternal immunization against respiratory syncytial virus (RSV) in infants: Evaluation for six European countries

Abraham M. Getaneh, Xiao Li, Zhuxin Mao, Caroline K. Johannesen , Elisa Barbieri, Jojanneke van Summeren, Xin Wang , Sabine Tong, Eugenio Baraldi, Emily Phijffer, Caterina Rizzo, Maarten van Wijhe, Terho Heikkinen, Louis Bont, Lander Willem, Mark Jit, Philippe Beutels, Joke Bilcke, for Respiratory Syncytial Virus Consortium in Europe (RESCEU) investigators



Respiratory syncytial virus (RSV) imposes a substantial burden on pediatric hospital capacity in Europe. Promising prophylactic interventions against RSV including monoclonal antibodies (mAb) and maternal immunizations (MI) are close to licensure. Therefore, we aimed to evaluate the cost-effectiveness of potential mAb and MI interventions against RSV in infants, for six European countries.


We used a static cohort model to compare costs and health effects of four intervention programs to no program and to each other: year-round MI, year-round mAb, seasonal mAb (October to April), and seasonal mAb plus a catch-up program in October. Input parameters were obtained from national registries and literature. Influential input parameters were identified with the expected value of partial perfect information and extensive scenario analyses (including the impact of interventions on wheezing and asthma).


From the health care payer perspective, and at a price of €50 per dose (mAb and MI), seasonal mAb plus catch-up was cost-saving in Scotland, and cost-effective for willingness-to-pay (WTP) values ≥€20,000 (England, Finland) or €30,000 (Denmark) per quality adjusted life-year (QALY) gained for all scenarios considered, except when using ICD-10 based hospitalization data. For the Netherlands, seasonal mAb was preferred (WTP value: €30,000-€90,000) for most scenarios. For Veneto region (Italy), either seasonal mAb with or without catch-up or MI was preferred, depending on the scenario and WTP value. From a full societal perspective (including leisure time lost), the seasonal mAb plus catch-up program was cost-saving for all countries except the Netherlands.


The choice between a MI or mAb program depends on the level and duration of protection, price, availability, and feasibility of such programs, which should be based on the latest available evidence. Future research should focus on measuring accurately age-specific RSV-attributable hospitalizations in very young children.


Respiratory syncytial virus (RSV); Disease burden; Cost-effectiveness analysis; Maternal vaccine; Monoclonal antibody; Seasonal program; Perspective; Expected value of perfect information (EVPI); Expected value of partial perfect information (EVPPI)

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