Economic Evaluations of RSV Preventive Strategies: A Systematic Review of Cost-Effectiveness and Modeling Approaches

Bingde Zhu^*Yuqiong LuYang ZhouWeixiao LiYuhang WuYujin BaoYun Lu^*

• China Pharmaceutical University, Nanjing, China

Background: Respiratory syncytial virus (RSV) causes significant morbidity and mortality worldwide, particularly in high-risk groups. Despite the availability of preventive interventions, it is crucial to evaluate the economic benefits of these interventions. Methods: This systematic review assessed the cost-effectiveness and model structures of RSV prevention strategies, including vaccines and monoclonal antibodies, by analyzing studies published up to March 2025. Results: A total of 39 studies were included, comprising one cost–benefit analysis (CBA) and 38 cost–effectiveness analyses (CEAs), utilizing six different types of economic models. The incremental cost-effectiveness ratio (ICER) among the elderly population varied from $5,342 to $385,829 per quality-adjusted life year (QALY). One study demonstrated superior cost-effectiveness of a long-acting monoclonal antibody (LAMA) compared to a short-acting monoclonal antibody, with both being more economically favorable than maternal vaccines for pregnant women and neonates. The most sensitive variables were intervention efficacy, price, and immunity duration. Conclusions: Most RSV vaccines and monoclonal antibody interventions demonstrate cost-effectiveness in specific populations and settings. However, cost-effectiveness is highly influenced by intervention price, efficacy, duration, populations, and administration time.Most RSV vaccines and monoclonal antibodies are cost-effective, particularly for high-risk populations. However, cost-effectiveness is highly influenced by intervention price, efficacy, duration, populations, and administration time.