Evaluating cost-effectiveness of RSV vaccination strategies for older adults in the Netherlands

Objective: This study evaluates the cost-effectiveness of respiratory syncytial virus (RSV) vaccination for older adults in the Netherlands, aiming to identify the most effective vaccination strategy. Methods: A static decision tree cost-effectiveness model was developed to compare no vaccination with various RSV vaccination strategies for Dutch adults over six RSV seasons. Strategies included vaccinating adults aged ≥60, ≥75, and ≥75 combined with high-risk individuals aged 60–74. Each was assessed with two- and three-year intervals. The model incorporated health outcomes and costs associated with RSV disease and vaccination from a societal perspective, with a lifetime horizon. Recent incidence data were used, and vaccine effectiveness was based on efficacy from a meta-analysis for outpatient settings and real-world effectiveness data for inpatient settings. A probabilistic sensitivity analysis was conducted, using a €50,000 per quality-adjusted life year (QALY) willingness-to-pay threshold. Results: Vaccinating individuals aged ≥75 years and high-risk groups every three years could prevent approximately 19,000 general practitioner visits, 3300 hospitalizations (including 245 intensive care admissions), and 870 deaths in the first year. This strategy would avoid €29.5 million in healthcare costs and €6.3 million in productivity losses, gaining 2900 QALYs. It was cost-effective, with an average cost-effectiveness ratio (ACER) of €30,804/QALY. The most cost-effective strategy was vaccinating ≥75 year-olds every three years, with an incremental cost-effectiveness ratio (ICER) of 23,080/QALY compared to no vaccination. Vaccinating all ≥60-year-olds every three years resulted in the highest QALY gain, with an ACER of €39,918/QALY. Compared to the ≥75 and high-risk strategy, this approach had an ICER of €107,623/QALY, whereas the 75+ and high-risk strategy had an ICER of €61,987/QALY compared to the ≥75 strategy alone. Biennial strategies were associated with higher ACERs and were dominated in incremental comparisons. Conclusion: RSV vaccination for older adults in the Netherlands can be cost-effective, particularly when vaccinating every three years.