Report of the WHO technical consultation on the evaluation of respiratory syncytial virus prevention cost effectiveness in low- and middle-income countries, April 7–8, 2022

• Published in: Vaccine 2023-11, Vol.41 (48), p.7047-7059
• Main Authors: Fitzpatrick, Meagan C., Laufer, Rachel S., Baral, Ranju, Driscoll, Amanda J., Feikin, Daniel R., Fleming, Jessica A., Jit, Mark, Kim, Sonnie, Koltai, Mihaly, Li, You, Li, Xiao, Nair, Harish, Neuzil, Kathleen M., Pecenka, Clint, Sparrow, Erin, Srikantiah, Padmini, Ortiz, Justin R.
• Format: Article
• Language: English
• Subjects: Cost analysis; Cost effectiveness; Cost-Benefit Analysis; Cost-Effectiveness Analysis; death; Developing Countries; Disease prevention; Economics; Epidemiology; Estimates; Fatalities; Geography; Global health; Health promotion; High income; Hospitalization; Hospitals; Humans; Immunization; Industrialized nations; Infant; Intervention; LDCs; Licenses; Monoclonal antibodies; Monoclonal antibody; Morbidity; Mortality; Older people; Parameter identification; Parameterization; Pneumonia; Prevention; prices; R&D; Referral and Consultation; Regulatory approval; Research & development; Respiratory syncytial virus; Respiratory Syncytial Virus Infections - epidemiology; Respiratory Syncytial Virus Infections - prevention & control; Respiratory Syncytial Virus, Human; Sensitivity analysis; stakeholders; Systematic review; Vaccine; Vaccines; Viruses; willingness to pay; World Health Organization
• ISSN: 0264-410X; 1873-2518
• DOI: 10.1016/j.vaccine.2023.09.040

•Respiratory syncytial virus (RSV) is an important pathogen globally.•The burden of RSV illness is highest in low/middle-income countries (LMICs).•In April 2022, WHO convened a meeting to discuss the economics of RSV prevention.•We reviewed cost-effectiveness analyses of RSV prevention in LMICs.•We provided recommendations for future data gathering to address data limitations. Policymakers often rely on impact and cost-effectiveness evaluations to inform decisions about the introduction of health interventions in low- and middle-income countries (LMICs); however, cost-effectiveness results for the same health intervention can differ by the choice of parameter inputs, modelling assumptions, and geography. Anticipating the near-term availability of new respiratory syncytial virus (RSV) prevention products, WHO convened a two-day virtual consultation in April 2022 with stakeholder groups and global experts in health economics, epidemiology, and vaccine implementation. The objective was to review methods, parameterization, and results of existing cost-effectiveness analyses for RSV prevention in LMICs; identify the most influential inputs and data limitations; and recommend and prioritize future data gathering and research to improve RSV prevention impact estimates in LMICs. Epidemiological parameters identified as both influential and uncertain were those associated with RSV hospitalization and death, specifically setting-specific hospitalization rates and RSV-attributable death rates. Influential economic parameters included product price, delivery costs, willingness-to-pay for health on the part of potential donors, and the cost of RSV-associated hospitalization. Some of the influential parameters identified at this meeting should be more precisely measured by further research. Other influential economic parameters that are highly uncertain may not be resolved, and it is appropriate to use sensitivity analyses to explore these within cost-effectiveness evaluations. This report highlights the presentations and major discussions of the meeting.