Evaluating preferences for long term wheeze following RSV infection using TTO and best-worst scaling

Roy, L.; Bansback, Nick; Marra, Carlo; Carr, Roxane; Chilvers, Mark; Lynd, Larry D.

doi:10.1186/1710-1492-10-s1-a64

Cited by 7 publications

(6 citation statements)

References 8 publications

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“…QALYs were calculated based on disutilities corresponding to the severity and duration of disease, with disutility weights obtained from published studies [ 32 , [50] , [51] , [52] ]. For severe cases needing hospitalization, we considered a disutility weight of 0.41 for the duration of stay in paediatric ward and 0.6 for the duration of ICU [50] , [51] , [52] . Disutility weights were 0.16 during outpatient treatment, and 0.12 with a previous RSV infection (post treatment) [ 32 , 50 ].…”

Section: Methodsmentioning

confidence: 99%

Effectiveness and cost-effectiveness of RSV infant and maternal immunization programs: A case study of Nunavik, Canada

et al. 2021

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Background Despite passive immunization with palivizumab to select high-risk children under two years of age, the health and economic burden of respiratory syncytial virus (RSV) remains substantial. We evaluated the effectiveness and cost-effectiveness of immunization programs with new generations of RSV prophylactics, including long-acting monoclonal antibodies (LAMA) and maternal vaccines, in terms of reducing hospitalizations in Nunavik, a Canadian Arctic region. Methods We developed an agent-based model of RSV transmission and parameterized it with the demographics and burden of RSV in Nunavik, Québec. We compared various immunization strategies, taking into account the costs associated with program delivery and calculating the incremental cost-effectiveness ratio (ICER) using quality-adjusted life-years (QALYs) gained as a measure of effectiveness. Scenario analyses included immunization with palivizumab and LAMA for infants under one year of age, and maternal vaccination in mild, moderate, and severe RSV seasons. Data were analysed from November 1, 2019 to May 1, 2021. Findings We found that a Nunavik pilot program with palivizumab which included healthy full-term infants aged 0–2 months in addition to those considered high-risk for complicated RSV disease is not cost-effective, compared to offering palivizumab only to preterm/chronically ill infants under 1 year of age. Using LAMA as prophylaxis produces ICER values of CAD $39,414/QALY (95% Credible Interval [CrI]: $39,314–$40,017) in a mild season (moderately cost-effective) and CAD $5,255/QALY (95% CrI: $5,222–$5,307) in a moderate season (highly cost-effective). LAMA was a dominant (cost-saving with negative incremental costs and positive incremental effects) strategy in a severe RSV season. Maternal vaccination combined with immunization of preterm/chronically ill infants 3–11 months was also a dominant (cost-saving) strategy in all seasons. Interpretation The switch from palivizumab in RSV immunization programs to new prophylactics would lead to significant savings, with LAMA being an effective strategy without compromising benefits in terms of reducing hospitalizations.

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Section: Methodsmentioning

confidence: 99%

Effectiveness and cost-effectiveness of RSV infant and maternal immunization programs: A case study of Nunavik, Canada

et al. 2021

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“…Although several cost-utility analyses included quality of life losses during the acute phase of RSV disease, no study so far incorporated actual utility losses estimated specific for the acute phase of RSV disease. After systematically reviewing the literature, we found only one study estimating utility weights specific for this phase of the disease [ 26 ], [ 27 ]. That study estimated disutility for 4 different states using the time-tradeoff (TTO) methodology: 1) mild RSV disease resulting in emergency room or family doctor’s office; 2) moderate RSV disease resulting in hospitalization; 3) severe RSV disease resulting in intensive care unit admission with oxygen support by mask-assisted breathing; and 4) very severe RSV disease resulting in intensive care unit admission with oxygen support by breathing machine.…”

Section: Methodsmentioning

confidence: 99%

Potential Cost-Effectiveness of RSV Vaccination of Infants and Pregnant Women in Turkey: An Illustration Based on Bursa Data

et al. 2016

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BackgroundWorldwide, respiratory syncytial virus (RSV) is considered to be the most important viral cause of respiratory morbidity and mortality among infants and young children. Although no active vaccine is available on the market yet, there are several active vaccine development programs in various stages. To assess whether one of these vaccines might be a future asset for national immunization programs, modeling the costs and benefits of various vaccination strategies is needed.ObjectivesTo evaluate the potential cost-effectiveness of RSV vaccination of infants and/or pregnant women in Turkey.MethodsA multi-cohort static Markov model with cycles of one month was used to compare the cost-effectiveness of vaccinated cohorts versus non-vaccinated cohorts. The 2014 Turkish birth cohort was divided by twelve to construct twelve monthly birth cohorts of equal size (111,459 new-borns). Model input was based on clinical data from a multicenter prospective study from Bursa, Turkey, combined with figures from the (inter)national literature and publicly available data from the Turkish Statistical Institute (TÜÏK). Incremental cost-effectiveness ratios (ICERs) were expressed in Turkish Lira (TL) per quality-adjusted life year (QALY) gained.ResultsVaccinating infants at 2 and 4 months of age would prevent 145,802 GP visits, 8,201 hospitalizations and 48 deaths during the first year of life, corresponding to a total gain of 1650 QALYs. The discounted ICER was estimated at 51,969 TL (26,220 US $ in 2013) per QALY gained. Vaccinating both pregnant women and infants would prevent more cases, but was less attractive from a pure economic point of view with a discounted ICER of 61,653 TL (31,106 US $ in 2013) per QALY. Vaccinating only during pregnancy would result in fewer cases prevented than infant vaccination and a less favorable ICER.ConclusionRSV vaccination of infants and/or pregnant women has the potential to be cost-effective in Turkey. Although using relatively conservative assumptions, all evaluated strategies remained slightly below the threshold of 3 times the GDP per capita.

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“…Pouwels et al [35] set the disutility for a GP-treated RSV infection at 0.16 and for a hospital-treated RSV infection at 0.43 per day, with an average duration of infection of 14 days. The authors referred to a Canadian study that derived health states for RSV in children and adults using time tradeoff and best-worst scales [42]. Régnier et al [23] estimated a QALY loss per RSV hospitalisation of 0.01 and a QALY loss of 0.005 and 0.008 for mild and severe cough (duration 10 days), respectively.…”

Section: Number Of Studiesmentioning

confidence: 99%

Assessment of the Effects of Active Immunisation against Respiratory Syncytial Virus (RSV) using Decision-Analytic Models: A Systematic Review with a Focus on Vaccination Strategies, Modelling Methods and Input Data

et al. 2021

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Background Several vaccine and antibody candidates are currently in development for the prevention of lower respiratory tract infections caused by the respiratory syncytial virus (RSV). Methods We searched MEDLINE, Embase, and SCOPUS and included model-based evaluations of RSV vaccinations. Two reviewers performed the selection, data extraction, and quality evaluation with EVIDEM. Cost-effectiveness (CE) estimates were converted to $US purchasing power parity (PPP), year 2018 values. Potential economic and epidemiological outcomes were summarised for maternal, infant, children, and elderly vaccinations. The PROSPERO identifier is CRD42019122570. Results In total, 22 model-based studies were reviewed. On average, a potential 27% reduction in RSV hospitalisations in infants was projected for maternal vaccination and 50% for direct infant immunisation. The CE of maternal vaccination was $US1766-5857 PPP 2018/disability-adjusted life-years (DALYs) for Global Alliance for Vaccines and Immunisation (Gavi)-eligible countries. For England, the maximum cost-effective price of maternal vaccination was estimated at $US81.5 PPP 2018. Infant vaccination was associated with higher CE ratios in low-and high-income settings. Vaccination of neonates born before the RSV season was the most cost effective in high-income settings. Higher values for vaccine effectiveness, duration of protection, and vaccine uptake increased the benefits. Due to indirect effects, the vaccination of school-age children and a cocooning strategy were effective alternatives to protect infants, and the vaccination of children aged < 5 years had a beneficial impact on the elderly. Conclusion RSV vaccines with anticipated characteristics may reduce a sizeable proportion of the RSV burden. The results are subject to uncertainty because of the limited epidemiological and clinical data. Data on RSV incidence and hospitalisation risk for granular age strata should be prioritised to facilitate the evaluation of RSV interventions and decision making.

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Evaluating preferences for long term wheeze following RSV infection using TTO and best-worst scaling

Cited by 7 publications

References 8 publications

Effectiveness and cost-effectiveness of RSV infant and maternal immunization programs: A case study of Nunavik, Canada

Effectiveness and cost-effectiveness of RSV infant and maternal immunization programs: A case study of Nunavik, Canada

Potential Cost-Effectiveness of RSV Vaccination of Infants and Pregnant Women in Turkey: An Illustration Based on Bursa Data

Assessment of the Effects of Active Immunisation against Respiratory Syncytial Virus (RSV) using Decision-Analytic Models: A Systematic Review with a Focus on Vaccination Strategies, Modelling Methods and Input Data

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