Nirsevimab for RSV Prevention in India: Economic Viability and Implementation Pathways for National Introduction: A Review

Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in Indian infants, with an estimated 800,000–1.2 million annual hospitalizations. Nirsevimab, a long-acting monoclonal antibody providing single-dose seasonal protection, has recently become available in India but remains cost-prohibitive for public health implementation. To evaluate the economic viability of Nirsevimab introduction in India and propose evidence-based implementation pathways aligned with national epidemiology and health system capacity. A structured review of RSV disease burden, Nirsevimab clinical efficacy, and economic evidence was undertaken. An India-specific cohort decision-analytic model was constructed using WHO-recommended cost-effectiveness thresholds. Deterministic and probabilistic sensitivity analyses were performed, and phased implementation pathways were developed, incorporating supply considerations, program readiness, and integration with existing immunization platforms. The manuscript was prepared in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA) guidelines. At current market prices (₹40,000–₹80,000 per dose), universal Nirsevimab would consume 9–17% of India’s public health expenditure while exceeding accepted cost-effectiveness thresholds. Economic modeling indicates an economically justifiable price of approximately ₹6,300 per dose. At ₹4,000 per dose, national introduction could prevent approximately 640,000 hospitalizations and 6,800 deaths annually while remaining highly cost-effective. Sensitivity analyses demonstrate robustness across plausible epidemiologic and pricing scenarios. Nirsevimab can become a cost-effective RSV prevention strategy in India if differential pricing reduces per-dose cost to ₹4,000–₹6,000. A phased introduction prioritizing high-burden regions and high-risk infants offers a pragmatic pathway for national adoption.