Quantifying the societal benefits of adult immunization against respiratory diseases in France: a benefit cost analysis

BACKGROUND: Pneumococcal disease, respiratory syncytial virus (RSV), influenza, and COVID-19 place a significant burden on France's population health, health system, and economy. Older adults and adults in clinical risk groups are recommended to receive vaccination against these illnesses, although RSV is not reimbursed. RESEARCH DESIGN AND METHODS: A benefit-cost analysis was conducted to assess the societal return on investment from adult vaccination by estimating benefit-cost ratios (BCRs) and net benefits (NBs). Health outcomes were monetized using established methods. Program costs included all direct vaccination-related expenditures. Scenario and sensitivity analyses assessed alternative program specifications and tested the robustness of the model. RESULTS: France's age-based respiratory immunization programs generate a BCR of €2.0 to €8.7 per €1 spent over the lifetime, depending on mortality risk reduction monetization. This corresponds to NBs of €9.7 to €72.6 billion. Introducing adult RSV vaccination with a similar uptake to that in the US could increase NBs by approximately 6%-7% compared to the status quo. Achieving aspirational coverage targets across all programs would increase NBs by 138%-175%. CONCLUSIONS: France's adult respiratory vaccination programs generate positive socioeconomic returns. Including adult RSV vaccination and increasing vaccination uptake would further increase their societal benefits. Realizing these gains requires adequate public investment.