Clinical and economic benefits of bivalent Respiratory syncytial virus prefusion F (RSVpreF) vaccine for prevention of RSV in adults: a cost-effectiveness analysis for Singapore

BACKGROUND: Respiratory syncytial virus (RSV) is a common virus causing severe illness in adults. RSV prefusion F protein subunit (RSVpreF) vaccine was approved by the Singapore Health Sciences Authority for adults aged 18-59 years at increased risk and for adults aged ≥ 60 years, to prevent RSV-associated lower respiratory tract disease. This study estimated the clinical and economic impact of RSVpreF vaccination for the prevention of RSV among adults in Singapore. RESEARCH DESIGN AND METHODS: A Markov model projected clinical and economic outcomes of RSV for the vaccination of adults with RSVpreF compared to no intervention. Analyses were conducted from the healthcare system perspective, with direct costs (2025 Singapore dollars [S$]) and outcomes discounted at 3% annually; scenario/sensitivity analyses tested model robustness. RESULTS: Compared to no intervention, RSVpreF vaccination would prevent 4,675 hospitalizations, 14,064 emergency department cases, and 37,631 outpatient visits over lifetime, averting S$31.92 million in direct medical costs with a gain of 2,675 quality-adjusted life years (QALYs). The RSVpreF vaccine would be cost-effective up to S$440.79/dose under a threshold of 1 ×gross domestic product per capita per QALY gained (S$122,370). CONCLUSIONS: RSVpreF vaccination would substantially reduce the clinical and economic burden of RSV among adults in Singapore.