What are the benefits of an RSV vaccine for older adults?

Research suggests that vaccination against respiratory syncytial virus for adults over 60 has a range of benefits.

According to the National Centre for Immunisation Research and Surveillance Australia, a single dose of RSV vaccine (Arexvy or Abrysvo) is recommended for people aged 75 years and over, First Nations people aged 60 years and over, and adults aged 60 years and over with conditions that increase their risk of severe RSV disease.

A new study conducted by researchers at the University of Michigan and the US Centers for Disease Control and Prevention — published in the journal Vaccine — evaluated both Arexvy and Abrysvo. It found that the vaccines are likely cost-effective by preventing illness, hospitalisations, lost quality of life and deaths.

“We view this as a pivotal study that highlights the potential of RSV vaccination to make significant public health and economic impacts for older adults,” said David Hutton, corresponding author of the study and professor of health management and policy and global public health at U-M’s School of Public Health.

Prior to the approval for vaccines in older adults, RSV immunisations were primarily recommended and used for high-risk infants. RSV is a common respiratory virus that can cause severe respiratory illness in young children, particularly those under a year old.

“As RSV continues to pose a serious threat to individuals in this age group, the goal is for these findings to provide timely insights for healthcare decision-makers and policymakers,” Hutton said.

How was the study conducted?

To determine cost-effectiveness, Hutton and colleagues evaluated the general population within the 60 and older age group and recorded RSV-associated healthcare utilisation, including outpatient appointments, emergency department visits, inpatient hospital stays and RSV deaths.

The researchers specifically analysed quality-adjusted life-years lost, or QALY, and societal costs that come with contracting RSV, and found the costs varied by age group and type of vaccine. The research also showed that vaccine efficacy, the incidence of RSV-related hospitalisations and vaccine costs had the most significant impact on the cost per QALY saved.

For example:

• For all adults aged 60 and older, the societal cost per QALY saved was $196,842 for GSK’s Arexvy and $176,557 for Pfizer’s Abrysvo.
• For adults aged 65 and older, the cost was lower at $162,138 for GSK and $146,543 for Pfizer.
• For adults between 60 and 64, the cost per QALY saved was notably higher at $385,829 for GSK and $331,486 for Pfizer.
   

Historically, efforts to prevent and treat RSV have focused on this younger population due to the high risk of hospitalisation and severe outcomes. Recognising similar risks for older populations, RSV vaccines were developed with the goal of preventing severe RSV-related illness, hospitalisation and death.

Looking to the future

The researchers concluded that RSV vaccination might be cost-effective for adults 60 and older, especially those of more advanced age. They noted that reduced vaccine costs and sustained efficacy beyond two RSV seasons could make RSV vaccination more cost-effective for a broader population. They also said that uncertainties remain, particularly around long-term vaccine efficacy.

“We look forward to continuing working with CDC to determine the best ways to use our health resources to prevent respiratory disease,” Hutton said.

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