Authors
David W Hutton, Lisa A Prosser, Ismael R Ortega-Sanchez, Andrew J Leidner, Fiona P Havers, Mila M Prill, Michael Whitaker, Lauren E Roper, Jamison Pike, Michael Melgar, Amadea Britton
Published in
Vaccine. Volume 90. Pages 129023. Aug 09, 2026. Epub Aug 09, 2026.
Abstract
Respiratory syncytial virus (RSV) disproportionately affects older adults with chronic conditions. RSV vaccines are effective but costly, and post-licensure studies suggest increased risk of Guillain-Barre syndrome (GBS). We evaluated cost-effectiveness and risk-benefit trade-offs of RSV vaccination by simulating RSV vaccination in adults aged ≥75 years and in adults aged 50-74 years with chronic conditions associated with increased risk of severe RSV disease. Data came from vaccine trials, peer-reviewed literature, observational vaccine effectiveness (VE) studies, and surveillance networks such as RSV-NET. Vaccine protection was assumed to last between 2 and 3 years. We estimated RSV vaccination averts more quality-adjusted life-years (QALYs) from RSV than vaccine-associated GBS. Societal cost-effectiveness varies substantially depending on age, risk condition, and duration of VE. RSV vaccination of adults aged ≥75 years costs $45,769 (95% uncertainty interval, UI: $25,505-$84,871) per quality-adjusted life-year (QALY) for protein subunit vaccines with 3 years of effectiveness; $100,571 (UI: $58,277-$225,885)/QALY for mRNA vaccine with 2 years of effectiveness; and $70,731 (UI: $42,069-$159,451) for mRNA vaccine with 3 years of effectiveness. Vaccination of adults aged 60-74 years with at least one chronic condition costs $21,721 (UI: cost-saving-$120,989)/QALY for protein subunit vaccines with 3 years effectiveness; $85,781 (UI: $3368-$409,467)/QALY for mRNA vaccine with 2 years of effectiveness; and $50,864 (UI: $3668-$249,938)/QALY for mRNA vaccine with 3 years of effectiveness. Vaccination of adults aged 50-59 years with at least one chronic condition costs $43,070 (UI: cost-saving-$266,769)/QALY for protein subunit vaccines with 3 years of effectiveness; $152,293 (UI: $1154-$811,138)/QALY for mRNA vaccine with 2 years of effectiveness; and $95,182 (UI: cost-saving-$682,508) for mRNA vaccine with 3 years of effectiveness. Regardless of the vaccine used, vaccination of adults aged 60-74 years without chronic conditions has high incremental cost effectiveness ratios ($287,793 to $503,328/QALY). If RSV disease had higher incidence, costs, or mortality, vaccination would be more cost-effective.
PMID:
42571751
Bibliographic data and abstract were imported from PubMed on 10 Aug 2026.
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