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Evaluating respiratory syncytial virus immunization strategies for infants in Canada: A cost-utility analysis

Author

Listed:
  • Gebremedhin B Gebretekle
  • Marie Lan
  • Min Xi
  • Raphael Ximenes
  • Sarah A Buchan
  • Elissa M Abrams
  • Melissa K Andrew
  • Nicholas Brousseau
  • April Killikelly
  • Deborah Money
  • Jesse Papenburg
  • Ellen Rafferty
  • Joan L Robinson
  • Winnie Siu
  • Matthew Tunis
  • Ashleigh R Tuite

Abstract

Background: Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections and hospitalizations among infants in Canada. New long-acting monoclonal antibodies (mAbs) and vaccines administered during pregnancy have expanded prevention options, yet the most cost-effective immunization program remains uncertain. Methods: We updated a Canadian cost-utility model to evaluate seven seasonal RSV prevention strategies over one year (with a lifetime horizon for mortality impacts), from health system and societal perspectives. Strategies included RSVpreF vaccination in late pregnancy; targeted or universal infant mAb programs using nirsevimab or clesrovimab; and combination programs in which infants could receive protection from either RSVpreF or mAbs. Sequential incremental cost-effectiveness ratios (ICERs) were estimated in 2024 Canadian dollars per quality-adjusted life year (QALY), using a $50,000/QALY threshold. The primary analysis used immunization product list prices. Findings: The most cost-effective strategy was a seasonal combination program: RSVpreF vaccination for pregnancies due during the RSV season, with mAb for infants at high risk (

Suggested Citation

  • Gebremedhin B Gebretekle & Marie Lan & Min Xi & Raphael Ximenes & Sarah A Buchan & Elissa M Abrams & Melissa K Andrew & Nicholas Brousseau & April Killikelly & Deborah Money & Jesse Papenburg & Ellen , 2026. "Evaluating respiratory syncytial virus immunization strategies for infants in Canada: A cost-utility analysis," PLOS ONE, Public Library of Science, vol. 21(6), pages 1-16, June.
    • Handle: RePEc:plo:pone00:0351183
    DOI: 10.1371/journal.pone.0351183
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