Evaluating respiratory syncytial virus immunization strategies for infants in Canada: A cost-utility analysis

Gebremedhin B Gebretekle, Marie Lan, Min Xi, Raphael Ximenes, Sarah A Buchan, Elissa M Abrams, Melissa K Andrew, Nicholas Brousseau, April Killikelly, Deborah Money, Jesse Papenburg, Ellen Rafferty, Joan L Robinson, Winnie Siu, Matthew Tunis and Ashleigh R Tuite

PLOS ONE, 2026, vol. 21, issue 6, 1-16

Abstract: Background: Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections and hospitalizations among infants in Canada. New long-acting monoclonal antibodies (mAbs) and vaccines administered during pregnancy have expanded prevention options, yet the most cost-effective immunization program remains uncertain. Methods: We updated a Canadian cost-utility model to evaluate seven seasonal RSV prevention strategies over one year (with a lifetime horizon for mortality impacts), from health system and societal perspectives. Strategies included RSVpreF vaccination in late pregnancy; targeted or universal infant mAb programs using nirsevimab or clesrovimab; and combination programs in which infants could receive protection from either RSVpreF or mAbs. Sequential incremental cost-effectiveness ratios (ICERs) were estimated in 2024 Canadian dollars per quality-adjusted life year (QALY), using a $50,000/QALY threshold. The primary analysis used immunization product list prices. Findings: The most cost-effective strategy was a seasonal combination program: RSVpreF vaccination for pregnancies due during the RSV season, with mAb for infants at high risk (

Date: 2026
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0351183

DOI: 10.1371/journal.pone.0351183

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