title: RSV vaccine in development: assessing the potential cost-effectiveness in the Dutch elderly population.
abstract: OBJECTIVE
  Respiratory syncytial virus (RSV) is increasingly recognized as an important cause of morbidity, mortality and health-care utilization in the elderly population. A theoretical model was built to assess the levels of vaccine effectiveness and vaccine costs for which a hypothetical RSV-vaccine for Dutch elderly could be cost-effective.
  
  
  METHODS
  Different vaccination strategies were evaluated by changing the levels of vaccine effectiveness and the willingness to pay per quality-adjusted life year gained (QALY). Outcome measures included direct medical costs, QALYs, life years gained, incremental cost-effectiveness ratios (ICERs) and the maximum total vaccination costs per individual (i.e. (vaccine price+administration costs)×nr of doses) while remaining cost-effective.
  
  
  RESULTS
  Using base-case assumptions, it was estimated that vaccination of all persons 60 years and older would prevent 3402GP visits, 2989 antibiotic prescriptions, 535 hospitalizations and 249 deaths and would cost €73,261 per QALY, for a vaccine effectiveness of 70%. Vaccinating only the high risk population of 60 years and older would reduce the estimates to 2042GP visits, 2009 antibiotic prescriptions, 179 hospitalizations and 209 deaths and this reduced the cost per QALY to €34,796 per QALY. Using the same assumptions, the maximum total vaccination costs per individual ranged from €26 when vaccinating all persons 60 and older to €68 when vaccinating only persons aged 85 and above, using a willingness to pay threshold of €50,000 per QALY. For the high risk population aged 60 years and older the estimated maximum total vaccination costs ranged from €52 to €99.
  
  
  CONCLUSIONS
  Vaccination of Dutch elderly against RSV was found cost-effective for several scenarios. As expected, vaccination is more likely to be cost-effective when only including persons who are at increased risk for contracting RSV or the potential complications of RSV. This theoretical study shows that based on the disease burden in the Dutch population aged 60yrs and older there is potential to develop a vaccine that might be considered cost-effective in the Netherlands.
authors.affiliation: Unit of PharmacoEpidemiology & PharmacoEconomics (PE(2)), Department of Pharmacy, University of Groningen, Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Meijboom
authors.forename: K B
authors.initials: KB
authors.lastname: Pouwels
authors.forename: W
authors.initials: W
authors.lastname: Luytjes
authors.forename: M J
authors.initials: MJ
authors.lastname: Postma
authors.forename: E
authors.initials: E
authors.lastname: Hak
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011788:Quality of Life; D018357:Respiratory Syncytial Virus Infections / Q000191:economics* / Q000453:epidemiology*; D022261:Respiratory Syncytial Virus Vaccines / Q000008:administration & dosage / Q000191:economics* / Q000276:immunology* / Q000302:isolation & purification
chemical_list: D022261:Respiratory Syncytial Virus Vaccines
keywords: Cost-effectiveness; Netherlands; Respiratory syncitial virus; Vaccination elderly