Public health impact and cost-effectiveness of the adjuvanted RSVPreF3 vaccine for respiratory syncytial virus prevention among adults aged 50 years and older in Germany

Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract disease in older adults. Vaccination is effective against RSV disease and can reduce disease and economic burden. A static, multicohort Markov model was adapted to the German setting to estimate the public health impact and cost-effectiveness of adjuvanted RSVPreF3 vaccination strategies from a societal perspective in three target populations: 1) at increased risk (AIR) adults aged 50–59 years and all adults ≥60 years, 2) all adults aged ≥60 years, and 3) AIR adults aged 60–74 years and all adults ≥75 years. A cycle length of 1 month and a 5-year time horizon were adopted. Vaccine coverage was 75% in the base case. RSV vaccination is cost-effective versus no vaccination (<€50,000 willingness-to-pay threshold): incremental cost-effectiveness ratios were €19,789, €19,631, and €12,733 for strategies 1, 2, and 3, respectively; 1.6, 1.4, and 0.8 million outpatient visits and 192,402, 185,238, and 152,781 hospitalizations could be prevented with strategies 1, 2, and 3, respectively. Expanding RSV vaccination to a larger target population would prevent more RSV cases, though at a higher cost per case averted; all vaccination strategies would be deemed cost-effective in Germany. Respiratory syncytial virus (RSV) usually causes cold-like symptoms in most adults. However, in infants, young children, older adults, and people with certain chronic conditions or a weakened immune system, RSV can lead to severe infections, hospitalization, or even death. There are three vaccines available that protect older adults against RSV disease. Current German guidelines have no preference for any of these three vaccines. We chose to study one vaccine only, the adjuvanted RSVPreF3 vaccine, which in Europe is licensed for people aged 50–59 years with underlying diseases and all people aged 60 or more years. We estimated how many physician visits, hospitalizations, and deaths could be prevented over 5 years if 75% of people aged 50–59 years with underlying diseases and all people aged 60 or more years were protected (strategy 1). We also looked at vaccinating only people aged 60 or more years (strategy 2) or vaccinating people aged 60–74 years with underlying diseases and all people aged 75 years or more, which is the current recommendation in Germany (strategy 3). Over 5 years, more than 1.6 million physician visits could be prevented with strategy 1, compared with 1.4 million visits with strategy 2 and 0.8 million visits with strategy 3. More hospitalizations were avoided with strategy 1 (192,402) than with strategies 2 (185,238) and 3 (152,781). Similarly, there were more RSV-related deaths prevented with strategy 1 (20,158) than with strategies 2 (19,869) and 3 (17,837). With strategy 1, 13 people need to be vaccinated to avoid 1 physician visit due to RSV, 26 people to prevent 1 severe RSV infection, and 106 people to prevent 1 hospitalization. Despite vaccination costs, all strategies are highly favorable from an economic perspective given the health gain obtained.