Multi-country economic evaluations of interventions against Respiratory Syncytial Virus (RSV) and influenza-like illness (ILI)

Both influenza virus and respiratory syncytial virus (RSV) are the leading causes of lower respiratory tract infections (LRTI) worldwide. A global disease burden study estimated 292 million LRTI episodes, of which 15% of incidence were attributable to RSV and 10.4% to influenza in all ages. Studies also showed younger children, older adults and people with comorbidities are most vulnerable to RSV and influenza virus. Oseltamivir, an oral antiviral drug, is available to treat influenza, but it is not reimbursed in most European countries. Several RSV prevention interventions are in advanced clinical phases and likely to be marketed in next few years. Economic evaluations have been widely used to assess the cost-effectiveness to inform decision making, not only on antiviral reimbursement, but also on preventative strategies before implementing a new immunisation programme. This thesis aims to evaluate the cost-effectiveness of interventions against influenza and RSV by using cost-effectiveness and cost-utility analyses with both trial-based and model-based approaches to facilitate public health policy making at country and multi-country levels. European decision makers could consider using oseltamivir to treat ILI in primary care setting is cost-effective within 72 hours of symptom onset. More studies on RSV-associated costs and health-related quality-of-life are needed, especially in older adults outside of hospital setting. When considering a new RSV immunisation year-round programme, monoclonal antibody would avert more disease burden compared to maternal vaccine based on the current available phase 3 data, as monoclonal antibody may offer higher efficacy and longer duration of protection. In countries with clear RSV seasonal patterns, the seasonal programmes are cost-effective compared to the year-round programmes given the relatively short duration of protection of the interventions. The most influential disease burden parameters in the Gavi-eligible countries are the RSV-associated hospitalisation burden and mortality. In a high-income country like Norway, the start time and severity of the RSV season are the most influential drivers. Hence, continued active RSV surveillance data at regional, national, and international levels are crucial.

Publication year:2022

Keywords:Doctoral thesis

Accessibility:Open