BROADER SOCIETAL CONSEQUENCES OF RSV INFECTION AMONG DANISH COPD PATIENTS OVER 60 YEARS - A SYSTEMATIC REVIEW, META-ANALYSIS AND HEALTH ECONOMIC ANALYSIS OF ABRYSVO

Abstract

Background: Respiratory Syncytial Virus (RSV) is one of the leading causes of lower respiratory tract infections, a condition that often leads to exacerbations of varying degrees in Chronic obstructive pulmonary disease (COPD) patients. In Denmark, there are an estimated 400.000 COPD patients who risk RSV-related exacerbations, hospital admissions, and ultimately death. Currently, no national immunization program is in place to prevent infection with RSV. Instead, the Standard of Care is based on symptomatic treatment, once infection and exacerbation have occurred. This study aims to assess the cost-effectiveness and budget impact of implementing nationwide vaccination of COPD patients over 60 years with Pfizer’s RSV vaccine ABRYSVO. Methods: A cost-utility analysis (CUA) based on a Markov model was conducted to address the aim. Input parameters; baseline health related quality of life (HRQoL) in COPD patients and HRQoL during exacerbation of COPD, were derived from two systematic reviews and meta- analyses. Other input parameters were sourced through gray literature searches and register data, with some requiring various degrees of arithmetic calculations. The Markov model included 20 cycles, each 1 year long. The ABRYSVO scenario included 31 possible health states, while the non-vaccination scenario included 16 health states. A state tracker was utilized to calculate the accumulation of disutility attributable to RSV-caused exacerbations to avoid a so-called state explosion. The robustness of the results was assessed using deterministic (DSA) and probabilistic sensitivity analysis (PSA), while a budget impact analysis (BIA) was conducted to determine the budgetary implications of implementing ABRYSVO as the standard of care. Results: The CUA results provided an incremental Quality Adjusted Life Years gain of 0, 00456 and an incremental cost of 1.086, 26 DKK. This translates to an incremental cost-effectiveness ratio of 238.067, 79 DKK, proving that, with a theoretical Willingness To Pay (WTP) of 450.000 DKK, ABRYSVO provides a cost-effective option for preventive treatment. Additionally, the BIA showed that year 1 would see an increased spending of 247.869.037, 77 DKK, while year 3 would see a saving of 17.760.743, 25 DKK. Moreover, the PSA showed that at the theoretical WTP of 450.000 DKK, ABRYSVO is cost-effective in approximately 66% of scenarios. While sensitivity analyses using ± 15% variation in WTP showed a probability of cost effectiveness of approximately 57% and 74% respectively. Conclusion: At a WTP threshold of 450.000 DKK, ABRYSVO provides a predominantly cost- effective treatment option. Additionally, the BIA was relatively high in the first year and tapered off in the subsequent years. The results display a higher quality of life for COPD patients due to reduced infection and overall severity. Furthermore, the implementation will reduce strain on the health sector and combat antibiotic resistance.

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A master thesis from Aalborg University

BROADER SOCIETAL CONSEQUENCES OF RSV INFECTION AMONG DANISH COPD PATIENTS OVER 60 YEARS - A SYSTEMATIC REVIEW, META-ANALYSIS AND HEALTH ECONOMIC ANALYSIS OF ABRYSVO