The upcoming RSV vaccine: Assessing the potential effectiveness and cost-effectiveness of different vaccination strategies in China

doi:10.21203/rs.3.rs-3814858/v1

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Research Article

The upcoming RSV vaccine: Assessing the potential effectiveness and cost-effectiveness of different vaccination strategies in China

https://doi.org/10.21203/rs.3.rs-3814858/v1

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Background Coinciding with the release of the respiratory syncytial virus (RSV) vaccines Arexvy and Abrysvo in Europe and the United States in 2023, and the clinical trials in China for Arexvy, we aimed to evaluate the cost-effectiveness of the diverse vaccination strategies in pregnant women, individuals aged 60, and those in the same age group at high risk with cardiovascular or respiratory diseases in China.

Methods We did a cost-effectiveness analysis in China, in which we developed a decision-making model of RSV to evaluate the effectiveness and incremental cost-effectiveness ratios of 22 intervention strategies, including diverse vaccination coverages (25%, 50%, 75%) of Arexvy and Abrysvo, as well as scenarios without vaccination, from a health-care system perspective with four different scenarios of US vaccine costs (25%/50%/75%/100%). We performed both univariate sensitivity analysis and probabilistic sensitivity analysis to assess the robustness of the model’s findings.

Results Compared with the absence of vaccination, various vaccination strategies would bring an additional cost of $-512.55-2719.8 million and 103.28-28811.06 Disability-Adjusted Life Years (DALYs) averted in the setting cohort over one year. With a willingness-to-pay threshold of three times of the Chinese per-capita gross domestic product (GDP), the most cost-effective strategy would be Abrysvo vaccination for 75% of pregnant women in all price settings with an incremental cost-effectiveness ratio of $-19116.29-21887.62 per DALY compared with no vaccination, and the cost-effectiveness frontier for all strategies further validated its dominance advantage. Consistent results were obtained in multiple extensive sensitivity analysis scenarios.

Conclusion Priority vaccination for pregnant women was the most cost-effective strategy for RSV prevention in China. Additionally, a potentially low RSV vaccine price in China might simultaneously incentivize vaccination in elderly population, especially those at high risk. The findings furnished crucial evidence that informed the development of effective vaccination policies to combat RSV in China.

Respiratory syncytial virus

Vaccination strategies

Cost-effectiveness

China

Disability-Adjusted Life Years

Respiratory syncytial virus (RSV) is a frequently encountered pathogen, capable of inducing severe morbidity, mortality, and imposing a substantial financial burden, particularly on vulnerable populations such as infants and the elders, especially those at high risk with cardiovascular or respiratory diseases[1, 2]. In 2019, an estimated 2.83 billion respiratory tract infections and about 400,000 deaths attributed to RSV were reported worldwide[3]. However, prior to the development of vaccines, the prevention of RSV relied solely on palivizumab, a humanized monoclonal antibody designed to target the respiratory syncytial virus[4].

In 2023, the RSV vaccines (Arexvy (GSK) and Abrysvo (Pfizer)) were approved in the United States and the Europe, specifically aiming to protect individuals aged 60 years and above. Additionally, Abrysvo obtained approval for use in pregnant population, aiming to safeguard infants[5]. China has been struggling with RSV disease burden with an estimated 14.69% and 7.51% of morbidity and mortality in 2019 alone[3]. Although the non-implementation of palivizumab for RSV prevention in China in consideration of efficacy, safety, and cost, the authorization of Arexvy for clinical trials in China signifies that the vaccination raises hope for adopting a preventive strategy to alleviate the burden of RSV-related diseases[6, 7].

Following the release of RSV vaccines and a rise in the incidence of respiratory infectious diseases attributed to a decline in the mask-wearing rate[8], we aimed to analyze the effectiveness and cost-effectiveness of a comprehensive array of combined strategies of vaccination with different vaccines and coverage in the population most likely to be affected by RSV to identify the most cost-effective strategy. Additionally, we evaluated the potential impact of future vaccine pricing in China on cost-effectiveness.

Study design

We conducted a model-based economic evaluation to assess the cost-effectiveness of 21 vaccination strategies, including a no-vaccination scenario, in China, from a health-care system perspective. The model was developed using Microsoft Excel 2019 and the analysis was reported according to the Consolidated Health Economic Evaluation Reporting Standards statement[9].

Modelling

A decision tree model was developed to simulate disease and health outcomes within a targeted vaccination population, including individuals aged 60 years, those aged 60 years with high risk of cardiovascular or respiratory disease, and pregnant women (Figure 1).

We determined the total number of individuals requiring vaccination based on China’s seventh population census, assuming that the number of pregnant women equated to the number of newborns[10].

We calculated the incidence of respiratory infections within the vaccinated population by multiplying the incidence of GBD (Global Burden of Disease) - reported and (1-vaccine effectiveness)[3].

Natural background mortality was excluded from the model since the study period was limited to only one year. Considering that the follow-up duration of the clinical trial was approximately 6 months, it was assumed to represent the vaccination protection period, which aligned with the majority of published cost-effectiveness literature[11-13].

In addition, given the favorable safety profile of vaccines in clinical trials, we did not incorporate the impact of adverse events in our modelling[5].

We assumed that the upper respiratory infections caused by RSV could be resolved spontaneously or with outpatient treatment. Conversely, lower respiratory infections were deemed more likely to necessitate additional medical help or intensive care admission[14-17].

Model parameters were defined in Table 1.

Table 1 Parameters for Cost-Effectiveness Analysis Decision Model

Parameter	Base case	Range (distribution)	Sources
Parameter	Base case	Range (distribution)	Sources
Queue population
Population of individuals aged 60	13280176		[10]
Population of individuals aged 60 at high risk	1819384		[18]
Annual number of pregnant women	9772477		[19]
Incidence rate
Upper respiratory tract infection
Population (<1)	46.33%	39.88%-53.18% (beta)	[3]
Population (60 years old)	38.62%	30.72%-46.83% (beta)
Lower respiratory tract infection
Population (<1)	0.78%	0.60%-1.03% (beta)
Population (60 years old)	1.21%	1.01%-1.45% (beta)
RSV-related respiratory tract infection
Population (<1)	19.50%	17.55%-20.48% (beta)	[20]
Population (60 years old)	16.00%	14.40%-16.80% (beta)	[20]
Mortality rate
Upper respiratory tract infection
Population (<1)	0.10%	0.05%-0.29% (beta)	[3]
Population (60 years old)	0.01%	0.01%-0.03% (beta)	[3]
Population (60 years old at high risk)	0.01%	0.01%-0.04% (beta)	[15]
Lower respiratory tract infection
Population (<1)	12.35%	10.85%-13.55% (beta)	[3]
Population (60 years old)	0.76%	0.71%-0.89% (beta)	[3]
Population (60 years old at high risk)	0.92%	0.86%-1.07% (beta)	[15]
Overview of treatment modality distribution
Upper respiratory tract infection
Outpatient treatment
Population (<1)	5.20%	4.68%-5.72% (beta)	[14]
Population (60 years old)	26.80%	24.12%-29.48% (beta)	[17]
Population (60 years old at high risk)	35.93%	32.34%-39.52% (beta)	[16]
Lower respiratory tract infection
Outpatient treatment
Population (<1)	26.80%	24.12%-29.48% (beta)	[15]
Population (60 years old)	17.39%	15.65%-19.13% (beta)
Population (60 years old at high risk)	28.57%	25.71%-31.43% (beta)
Hospitalization
Population (<1)	22.00%
Population (60 years old)	24.48%	0.43%-77.60% (beta)
Population (60 years old at high risk)	32.82%	23.49%-43.74% (beta)
Intensive care hospitalization
Population (<1)	8.60%
Population (60 years old)	5.01%	0.47%-37.36% (beta)
Population (60 years old at high risk)	26.74%	20.40%-34.22% (beta)
Vaccine efficacy
Arexvy, GSK	82.60%	57.90%-94.10% (beta)	[5]
Abrysvo, Pfizer
Population (<1)	81.80%	40.60%-96.30% (beta)
Population (60 years old)	66.70%	28.80%-85.80% (beta)
Duration, months	6.00	2.00-10.00 (gamma)
Cost, US$
Vaccine/dose (US)
Arexvy, GSK	270.00		[21]
Abrysvo, Pfizer	200.00		[21]
Vaccination/dose	3.36	3.03-3.53 (gamma)	[22]
Treatment
Outpatient treatment	16.02	14.42-16.82 (gamma)	[23]
Hospitalization	654.61	589.15-687.34 (gamma)
Intensive care hospitalization	1053.12	947.80-1105.77 (gamma)
Productivity losses due to deaths (<1)	339682.27	12074.77-2390362.39 (gamma)	Calculated
Utility, YLDs or YLLs
No treatment or outpatient treatment, YLDs	0.0037	0.0033-0.0039 (beta)	[24]
Hospitalization, YLDs	0.0102	0.0092-0.0107 (beta)	[24]
Death (<1), YLLs	17.39	13.4-80.79 (gamma)	Calculated
Death (60), YLLs	12.88	12.57-38.64 (gamma)	Calculated

Intervention strategies

We defined the absence of vaccination as the status quo in China because the vaccines were unavailable in China. A total of 21 vaccination strategies were investigated in our study, comprising a combination involving three potential vaccinated population with two vaccines, each at three different vaccination coverage levels (25%, 50%, and 75%). We assumed that vaccination was implemented when the cohort entered the model, with pregnant women receiving vaccination during labor, providing six months of protection for the infants.

Data analysis

The costs of treatment encompassed the costs of diagnosis, hospitalization, and medicines (Table 1). The costs of vaccination encompassed the vaccine price (25%/50%/75%/100% of US prices), the cost of staff services during vaccination, and the cost of advocacy for vaccination. All costs were converted from Chinese RMB to US dollars ($1=¥7.1254, applicable in 2023)[25]. To estimate the lost productivity from early infant mortality, we employed established formulas[26].The discount rate and wage growth rate were set at 3% (0-6%) and 4.9% (0-8%), respectively[27, 28], and the natural mortality rate assumed remains relatively stable in the future, derived from population census[10].

Notes: r=discount rate, g=wage growth rate, p_i=probability of surviving to year i, M_i= productivity loss for surviving to year i, N=natural mortality rate, GDP2022=China's GDP per capita in 2022. The retirement age in China was about 60 years old, so we had only calculated the productivity loss due to the early deaths of infants.

We selected Disability-Adjusted Life Years (DALYs) as the measure of effectiveness, and DALY was the summation of Years Lost Due to Disability (YLD) and Years of Life Lost (YLL). We obtained YLD from published literature (Table 1) and calculated YLLs using the formula.

The expected DALYs and costs for each strategy were derived from the model. We calculated the incremental costs and Averted DALYs for each vaccination strategy compared with a scenario of no vaccination across four price settings. We identified the cost-effectiveness frontier and calculated the incremental cost-effectiveness ratio (ICER), defined as the incremental cost per DALY averted for each strategy on the cost-effectiveness frontier compared with a lower-cost non-dominated strategy to ascertain the most cost-effective strategy. We adhered to the criteria of cost-effectiveness from WHO (classified as highly cost-effective, cost-effective, or not cost-effective based on an ICER <1, 1–3, or >3-times the per-capita gross domestic product [GDP]; Chinese per-capita GDP was $12741 in 2023)[29].

The selection of distribution for all parameters was based on consideration of the properties of the parameters and data informing the parameters (Table 1).

Univariate sensitivity analysis was conducted for each parameter within its respective ranges to pinpoint the most sensitive parameters. Probabilistic sensitivity analysis was performed through 10,000 simulations to establish the probability of cost-effectiveness for each intervention strategy compared with all others. The reporting of methods and results conformed to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) (as shown in the Supplement Table 1)[9].

We calculated the incremental costs and averted DALYs for 21 vaccination strategies compared to a scenario with no vaccination within the specified cohort of pregnant women and the elderly over one-year period (as shown in the Table 2).

Projected health outcomes

Over all, vaccination strategies would yield substantial health benefits compared with no vaccination. At 25%, 50% and 75% vaccination coverage settings, 9373-158693 (0.52%-8.74%), 18747-317386 (1.03%-17.48%), 28120-476078 (1.55%-26.22%) RSV-related upper respiratory infections would be averted, and alleviated 294-3664 (0.67%-8.31%), 588-7327 (1.33%-16.62%), 881-10991 (2.00%-24.92%) respiratory infections, 3452-23811 (1.09%-7.54%), 6904-47621 (2.19%-15.08%), 10355-71431 ( 3.28%-22.63%) outpatient treatment, 96-859 (0.90%-8.01%), 193-1718 (1.80%-16.03%), 289-2577 (2.70%-24.04%) hospitalizations, 78-238 (2.23%-6.78%), 157-476 (4.47%-13.57%), 235-714 (6.71%-20.35%) intensive care hospitalizations and 4-301 (0.13%-9.90%), 8-602 (0.25%-19.80%), 12-903 (0.38-29.70%) deaths, totaled the equivalent of averted 103.28-9603.69 (0.11%-9.94%) , 255.80-17874.78 (0.26%-18.50%), 309.83-28811.06 (0.32%-29.81%) DALYs.

Among all vaccination strategies, 75% of individuals aged 60 and pregnant women vaccinated with Abrysvo was most effective, resulting in the highest number of averted deaths and DALYs.

Detailed effectiveness results were presented in Supplement Table 2.

Cost-effectiveness analysis

Overall, vaccination strategies in 25%, 50%, 75%, and 100% US vaccine price settings would result in an additional cost of $-512.55 to 702.96, $-146.08 to 1375.27, $69.55 to 2047.58 and $92.30 to 2719.89 million.

Figure 2 illustrates the optimal cost-effective strategy based on willingness-to-pay (WTP) thresholds. On the cost-effectiveness frontier, vaccination for pregnant women or also for individuals aged 60 at high risk with Abrysvo proves to be cost-saving compared with no vaccination, particularly at 25% or 50% of the U.S. vaccine price. Vaccination for 25%/50%/75% pregnant women with Abrysvo or also for individuals aged 60 at high risk was deemed cost-effective compared to no vaccination at 100% U.S. price setting, considering three-times the per-capita GDP (ICER=$21887.62 and $31846.61 per DALY), and vaccination exclusively for pregnant women proved cost-effective compared to no vaccination, given one-time the per-capita GDP threshold at the 75% price setting (ICER=$8219.65 and $15819.22 per DALY), and vaccination for pregnant women and also for individuals aged 60 at high risk was considered cost-effective compared to no vaccination at one-time the per-capita GDP at the 50% price setting (ICER=$-5448.32 and $-208.17 per DALY). Vaccination for pregnant women and also for individuals aged 60 at high risk at one-time the per-capita GDP compared to no vaccination (ICER=$-5448.32 and $-208.17 per DALY), vaccination for pregnant women and individuals aged 60 with Abrysvo was cost-effective at three-times the per-capita GDP compared to no vaccination (ICER=$30583.01 per DALY), and all three of the above strategies were cost-effective at one-time the per-capita GDP threshold at 25% of the U.S. price setting (ICER=$-19116.29, $-16235.55, and $578.05 per DALY).

Table 2 Cost-effectiveness analysis

Strategies			Treatment cost, US$ (million)	Vaccination cost, US$ (million) (25%-100%)	GDP loss, US$ (million)	Total cost, US$ (million) (25%-100%)	DALYs	ICER, US$/QALY (25%)	ICER, US$/QALY (50%)	ICER, US$/QALY (75%)	ICER, US$/QALY (100%)
Strategies			Treatment cost, US$ (million)	Vaccination cost, US$ (million) (25%-100%)	GDP loss, US$ (million)	Total cost, US$ (million) (25%-100%)	DALYs	ICER, US$/QALY (25%)	ICER, US$/QALY (50%)	ICER, US$/QALY (75%)	ICER, US$/QALY (100%)
No vaccination			15.77	0.00	2941.58	2957.35	3042.00
Vaccination strategies
Coverage	Vaccine	Population
25%	Arexvy	60	14.83	235.26-907.57	2941.58	3191.67-3863.98	3013.30	283980.88	555577.49	827174.11	1098770.72
	Arexvy	60 high	15.52	32.23-124.34	2941.58	2989.33-3081.44	3037.21	250056.16	490110.18	730164.21	970218.23
	Abrysvo	Pregnant	15.33	130.36-496.83	2640.80	2786.50-3152.97	2763.97	-19116.29*	-5448.32*	8219.65*	21887.62**
		60	15.01	177.16-675.16	2941.58	3133.75-3631.76	3018.81	264747.81	513888.58	763029.35	1012170.12
		60 high	15.57	24.27-92.5	2941.58	2981.42-3049.64	3038.12	233056.78	453262.93	673469.07	893675.21
		60 + Pregnant	14.58	307.52-1172	2640.80	2962.90-3827.37	2740.84	578.05*	30583.01**	60587.96	90592.91
		60 high + Pregnant	15.13	154.64-589.33	2640.80	2810.57-3245.26	2760.15	-16235.55*	-208.17*	15819.22**	31846.61**
50%	Arexvy	60	13.90	470.52-1815.13	2941.58	3425.99-4770.61	2984.65	713517.39	1395918.66	2078319.92	2760721.19
	Arexvy	60 high	15.27	64.46-248.67	2941.58	3021.31-3205.52	3032.47	250056.16	490110.18	730164.21	970218.23
	Abrysvo	Pregnant	14.89	260.73-993.67	2340.02	2615.65-3348.58	2486.00	-19116.29*	-5448.32*	8219.65*	21887.62**
		60	14.26	354.32-1350.33	2941.58	3310.15-4306.16	2995.68	264747.81	513888.58	763029.35	1012170.12
		60 high	15.37	48.54-184.99	2941.58	3005.49-3141.94	3034.29	233056.78	453262.93	673469.07	893675.21
		60 + Pregnant	13.38	615.04-2343.99	2340.02	2968.45-4697.4	2439.73	578.05*	30583.01**	60587.96	90592.91
		60 high + Pregnant	14.49	309.27-1178.66	2340.02	2663.79-3533.18	2478.34	-16235.55*	-208.17*	15819.22**	31846.61**
75%	Arexvy	60	12.96	705.77-2722.7	2941.58	3660.31-5677.24	2956.00	713517.39	1395918.66	2078319.92	2760721.19
	Arexvy	60 high	15.02	96.69-373.01	2941.58	3053.29-3329.61	3027.73	250056.16	490110.18	730164.21	970218.23
	Abrysvo	Pregnant	14.46	391.09-1490.5	2039.25	2444.80-3544.2	2208.02	-19116.29*	-5448.32*	8219.65*	21887.62**
		60	13.50	531.47-2025.49	2941.58	3486.55-4980.57	2972.55	264747.81	513888.58	763029.35	1012170.12
		60 high	15.17	72.81-277.49	2941.58	3029.56-3234.24	3030.46	233056.78	453262.93	673469.07	893675.21
		60 + Pregnant	12.19	922.57-3515.99	2039.25	2974.00-5567.43	2138.63	578.05*	30583.01**	60587.96	90592.91
		60 high + Pregnant	13.85	463.91-1767.99	2039.25	2517.01-3821.09	2196.54	-16235.55*	-208.17*	15819.22**	31846.61**

Notes: *This strategy was cost-effective compared to no vaccination at one-time the per-capita GDP. **This strategy was cost-effective compared to no vaccination at three-times the per-capita GDP. DALY = disability-adjusted-life-year. GDP = gross domestic product.

Sensitivity analyses

Figure 3 illustrates that specific parameters such as discount rate, wage growth rate, mortality rate of upper respiratory infections <1-year-old and incidence of lower respiratory infections <1-year-old notably influenced the outcomes. However, varying all parameters did not substantially vary the ranking of cost-effectiveness of 22 strategies. We evaluated the cost-effectiveness for all strategies with a 0% discount rate, revealing that vaccination for both pregnant women and individuals aged 60 was cost-saving compared to no vaccination. We evaluated the cost-effectiveness for all strategies at a 6% discount rate, indicating that vaccination for pregnant women was cost-effective compared with no vaccination at 50% U.S. vaccine price setting at three-times the per-capita GDP thresholds.

Figure 4 illustrates the cost-effectiveness acceptability curves across all strategies within a range of WTP, spanning from 0 to five-times the per-capita GDP. At a WTP threshold of three-times the per-capita GDP, vaccination for 75% pregnant women demonstrates a probability exceeding 50% of being cost-effective, surpassing other strategies across all price settings. This strategy exhibits probabilities of cost-effectiveness at 61%, 73.04%, 86.34%, and 96.96% across four price settings and outperformed alternative strategies even at a WTP threshold of 0 at 25% or 50% U.S. price settings. Furthermore, when the thresholds exceeded $11,223.75 and $24,164.39, the strategy maintains a probability of more than 50% in cost-effectiveness, at 75% or 100% U.S. price settings.

Coinciding with the release of the respiratory syncytial virus (RSV) vaccines, Arexvy and Abrysvo, in Europe and the United States in 2023, and the clinical trials in China for Arexvy, we comprehensively analyzed the effectiveness and cost-effectiveness of various vaccination strategies, considering different vaccine price settings. Our findings indicate, that, among all strategies, vaccination for 75% pregnant women with Abrysvo emerged as the most cost-effective strategy and should be the prioritized for RSV prevention in China when the vaccine is available.

Our research indicated that pregnant women emerged as the highest priority for vaccination compared to other strategies at current WTP threshold of three-times the per-capita GDP in all price settings. The potential obstacle of high vaccination price might impede the implementation of vaccination programs for the elderly, even those at high risk, given that the mortality rate of respiratory infections of elder population was lower than that of infants[3]. Notably, the impact of deaths was large in the number of YLLs and loss of productivity, far more extending beyond illness, and the potential loss of productivity from infant mortality was undoubtedly substantial from a economic perspective[26].

Our study demonstrated that RSV vaccination might avoid approximately $211,397.46-$35,123,321.41 per year in RSV-related healthcare costs compared to no vaccination, which was expected to save approximately 1.28%-22.73% of healthcare costs, and that RSV vaccination might be an attractive option in China, and that its attractiveness grows as the price decreases. The potential reduction in RSV vaccine price compared to U.S. in the foreseeable future could further facilitate the implementation of broader RSV vaccination programmes, particularly in the elder population, especially those with cardiovascular or respiratory diseases. With the implementation of price negotiation and centralized procurement strategies by the Chinese Government, there exists the potential to substantially reduce vaccine prices in the future.

Besides, as more alternative RSV vaccines developed in the future, manufacturers could gain market share by lowing prices amid intense market competition. In this context, our model suggested that, should the cost of Abrysvo vaccination drop to below $50 per dose, the cost-effective priority order for the population should be pregnant women, older individuals at high risk, and all older individuals at a low WTP of one-time the per-capita GDP. Only when the vaccination cost further decreased and the target population has already been vaccinated, then should the consideration of vaccinating young adults become necessary.

In contrast to previous studies on RSV vaccination in middle- or low-income countries or regions, though the reasons for vaccination recommendations differ, the conclusions are convergent[11-13, 30]. We focused on the health and productivity impacts of deaths, while previous researches opted for a lower vaccine price, possibly influenced by findings such as Global Alliance for Vaccines and Immunization (Gavi). But neither the fact that we set lower prices nor the fact that other researchers gave more consideration to the impact of deaths would have had an impact on the conclusions.

Our study encountered several limitations. First, we employed a static model, overlooking the effects of herd immunity. Consequently, this method was likely to underestimate the population effects and cost-effectiveness associated with vaccination interventions, but it would not alter our conclusion. Second, although we accounted for risk groups among the elderly, the absence of sufficient epidemiological data hindered a more detailed delineation. While what we have done might seem comprehensive and adequate, it was constrained by the unavailability of vaccines in China at the time. Third, some parameters used in our study originated from different studies. For example, the epidemiological parameters of RSV were derived from Global Burden of Diseases (GBD) 2019, and although updated epidemiological parameters exist, they were predominantly region-specific within China and lacked national representativeness. Moreover, we found a rising incidence of RSV in China, suggesting that our methodology again underestimated the population effects and cost-effectiveness of vaccination strategies[3]. Fourth, owing to the absence of specific parameters, such as age-weighting coefficients, the calculation of YLD in our study primarily relied on literature from China. Additionally, YLL was determined using a more straightforward methodology.

In conclusion, prioritizing vaccination for pregnant women emerged as the most cost-effective strategy for RSV prevention in China in all price settings. A potentially low RSV vaccine price in China might simultaneously appeal to older individuals to undergo vaccination as well, especially those at high risk. The findings furnished important evidence to shape informed RSV prevention vaccination policies in China. Our study contributed important evidence for RSV trials and vaccination strategies in China.

Ethics approval and consent to participate

Not applicable. This was a cost-effectiveness analysis based on publicly available data, and the ethical statement was not applicable.

Consent for publication

Not applicable.

Availability of data and materials

All cost data used in this study were available at the following public link:

PubMed: https://pubmed.ncbi.nlm.nih.gov/

GBD Results: https://vizhub.healthdata.org/gbd-results/

National Bureau of Statistics C: https://www.stats.gov.cn/sj/ndsj/2022/indexch.htm

Competing interests

The authors declare that they have no competing interests.

Funding

This work was supported by Bill & Melinda Gates Foundation (Project: Full-value driven decision-making support platform (DSP) and management mechanism for rapid vaccine R&D, efficient trial design and scientific regulation: from a public administration perspective, Number: 2023YFVA1002). Jiangsu Medical Products Administration, China (Project: Construction and Application of an Evaluation System of Vaccines in Emergency and Non-Emergency in Jiangsu Province, Number: 8210030073/002) and NHC Key Laboratory of Health Technology Assessment (Fudan University).

Authors' contributions

WT, Dc-Z and HF obtained funding. WT and Dc-Z designed the study, and Dc-Z and KZ collected the data. Dc-Z, KZ, and WW were involved in the data cleaning and verification. WT and Dc-Z led the model developments and statistical analyses. Dc-Z, KZ, WW and DZ supervised the analyses. Dc-Z and KZ drafted and finalized the manuscript. WT, WW, KZ and DZ contributed to the critical review and revision of the manuscript. Dc-Z, KZ, HF and WW contributed to the interpretation of the results. All authors read and approved the final manuscript.

Acknowledgements

Not applicable.

Authors' information (optional)

Dachuang Zhou, Ph.D. candidate, specializing in Health Economics, E-mail: [email protected],

Kejia Zhou, M.S. candidate, specializing in Health Economics, E-mail: [email protected],

Wenjuan Wang, M.S. candidate, specializing in Health Policy and Management, E-mail: [email protected],

Di Zhang, B.S., specializing in Pharmaceutical Business Management, E-mail: [email protected],

Hongshu Fang, M.S. candidate, specializing in Health Policy and Management, E-mail: [email protected]

Wenxi Tang, Ph.D., specializing in Health Economics, E-mail: [email protected]

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The upcoming RSV vaccine: Assessing the potential effectiveness and cost-effectiveness of different vaccination strategies in China

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