Cost-effectiveness of RSVpreF for the prevention of respiratory syncytial virus illness among high-risk adults in Germany

INTRODUCTION: Vaccination against lower respiratory tract illness due to respiratory syncytial virus (RSV-LRTI) is approved in Europe for all adults aged ≥18 years. The German Standing Committee on Vaccination (STIKO), however, only recommends vaccination for high-risk adults aged 60-74 years and all adults aged ≥75 years (standard of care [SOC]). Younger, immunocompromised adults [IC], as well as those with chronic medical conditions [CMC+], remain unprotected. RESEARCH DESIGN AND METHODS: A multi-cohort model projected lifetime RSV-related clinical and economic outcomes (in 2025 €) among adults in Germany. Base case analyses considered the cost-effectiveness of adding vaccination of IC adults aged 18-59 years to the SOC from a societal perspective. An expanded base case adding CMC+/IC adults aged 18-59 years to the SOC was also evaluated. RESULTS: Adding IC adults aged 18-59 years to the recommendation would prevent 6,490 additional cases, avert 199 more deaths, and reduce costs by 21 million € compared to the SOC. Incorporating CMC+/IC adults would prevent 24,545 additional cases and 388 deaths, at an incremental cost of 238 million €. CONCLUSIONS: Expanding the recommendation to include IC or CMC+/IC adults aged 18-59 years could substantially reduce the clinical burden of RSV-LRTI in Germany; including IC 18-59-year-olds would also be cost-saving.