Cost-effectiveness of infant and maternal RSV immunization strategies, in British Columbia, Canada

Critical Summary This article evaluates the cost-effectiveness of recently available respiratory syncytial virus (RSV) immunization options—nirsevimab (a long-acting monoclonal antibody) and the maternal RSVpreF vaccine—compared with the historical use of palivizumab among infants at high risk for severe RSV outcomes. Using a discrete-event simulation grounded in a birth cohort of 100,000 children and ten years of provincial epidemiologic and hospitalization data from British Columbia, the authors assess five immunization strategies to guide provincial and national policy. The study’s main contribution is its integration of age-specific, seasonally varying RSV hospitalization risk with risk-group stratification for high-, moderate-, and low-risk infants. Prior Canadian analyses had not fully addressed differences in seasonality, comorbidity-adjusted ICU risk, or contemporaneous hospitalization costs—gaps the authors explicitly seek to fill. Their model simulates RSV infections, healthcare utilization, and QALY loss over the first two years of life, assigning direct medical costs and intervention costs from the health-system perspective. The strategies...