Burden of paediatric respiratory syncytial virus disease and potential effect of different immunisation strategies: a modelling and cost-effectiveness.

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Burden of paediatric respiratory syncytial virus disease and potential effect of different immunisation strategies: a modelling and cost-effectiveness analysis for England Dr Deborah Cromer, PhD, Albert Jan van Hoek, PhD, Anthony T Newall, PhD, Andrew J Pollard, FMedSci, Mark Jit, PhD The Lancet Public Health Volume 2, Issue 8, Pages e367-e374 (August 2017) DOI: 10.1016/S2468-2667(17)30103-2 Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 1 Outcomes attributable to respiratory syncytial virus by month of birth (A) General practitioner (GP) consultations, (B) admissions to hospital. The Lancet Public Health 2017 2, e367-e374DOI: (10.1016/S2468-2667(17)30103-2) Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 2 Cases of respiratory syncytial virus averted and costs or QALYs saved for different vaccination strategies with complete vaccine efficacy Data given per 100 annual births for (A) general practitioner (GP) consultations averted,(B) hospital admissions averted, (C) deaths in hospital averted, (D) health-care costs saved, (E) QALYs saved, and (F) maximum cost-effective price (MCEP) of vaccination strategy. M=maternal immunisation strategy. N=newborn passive immunisation strategy. C=infant strategy, N+C=newborn and infant strategies. ICU=intensive-care unit. QALY= quality-adjusted life-year. The Lancet Public Health 2017 2, e367-e374DOI: (10.1016/S2468-2667(17)30103-2) Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 3 Ten most cost-effective periods over which to offer newborn vaccination or prophylactic antibodies against respiratory syncytial virus Red shading shows the birth months of the children that are most cost-effective to protect via a newborn strategy. Prices are per fully protected child for vaccination or prophylactic antibodies. All of the ten most cost-effective programmes involved protecting newborn infants for 5 months or less of the year, the top nine protected for 4 months or less, and the top eight recommended protecting children born in November. The Lancet Public Health 2017 2, e367-e374DOI: (10.1016/S2468-2667(17)30103-2) Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 4 Sensitivity to model parameters of cost-effectiveness calculations for respiratory syncytial virus vaccination (A) Infant strategy. (B) Newborn infant strategy. (C) Maternal strategy. Bars show by how much the maximum cost-effective price changes from its base case level when model parameters are varied. Changing the discounting strategy, or excluding deaths from the model, had little effect on the maximum cost-effective price (MCEP) estimates. Similarly, modifying the costs or quality-adjusted life-years (QALYs) associated with each health-care outcome had little effect on model estimates. The Lancet Public Health 2017 2, e367-e374DOI: (10.1016/S2468-2667(17)30103-2) Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions