04 Ortega Sanchez Adult RSV 508

This slide deck was prepared by Dr. David Hutton
of the University of Michigan and reflects his work.
It is being presented by CDC staff on his behalf. Dr.
Hutton will be available to answer questions at the
end of this presentation.
1
Economic Analysis of Protein Subunit
and mRNA RSV Vaccination in Adults
aged 50 -59 Years
David W. Hutton, PhD, MS
Associate Professor, Health Management and Policy, School of Public Health
Associate Professor of Global Public Health, School of Public Health
Associate Professor, Industrial and Operations Engineering, College of Engineering
University of Michigan
2This slide deck was prepared by Dr. David Hutton of the University of Michigan and reflects his work. It is being
presented by Dr. Ismael Ortega -Sanchez (CDC) on his behalf.
Presentation for the Advisory Committee on Immunization Practices, April 16th, 2025
Research Team
University of Michigan
•David Hutton, PhD
•Lisa Prosser, PhD
•Angela Rose, MPH
•Christina Nyamuswa , MSCDC
•Michael Melgar, MD
•Amadea Britton, MD
•Lauren Roper, MPH
•Mila Prill, MSPH
•Amber Kautz, PhD
•Jamison Pike, PhD
•Ismael Ortega -Sanchez, PhD
•Andrew Leidner, PhD
•Fiona Havers, MD
•Michael Whitaker, MPH
•Rebecca Woodruff, PhD
•Gordana Derado, PhD
•Huong Pham, MPH
3
Conflicts of interest  statements
•No known conflict of interests.
4
Study Question
•Evaluate the Cost -Effectiveness of RSV vaccination
•Compare vaccination to no vaccination using an incremental cost -effectiveness
ratio
•Scenario Analyses
•Perspective: Societal
•Focus: Age 50 -59
•We will show some results for other age groups as well
5
Methods
6
Methods: Intervention(s)
•Target population: US adults aged ≥50 years, stratified by age, chronic
medical conditions
•Adults aged 50 -59 years with at least one chronic medical condition*
•Adults aged 60 -74 years with at least one chronic medical condition*
•Adults aged ≥75 years
•Interventions: RSV vaccination
•Protein subunit RSV vaccination (Pfizer’s ABRYSVO, GSK’s AREXVY)
•Moderna RSV vaccination (Moderna’s mRESVIA )
•Each compared to no vaccination
7*For base case, at least one of: chronic obstructive pulmonary disease (COPD), asthma, coronary artery disease, chronic
kidney disease, diabetes mellitus, severe obesity (BMI ≥40)
Methods: Decision Tree Model
8No
Vaccination
VaccinationInfection Hospitalization
ED
None of the aboveOutpatientAlive
Dead
Box A.  RSV Infection
Methods: Decision Tree Model
9No
Vaccination
VaccinationInfection Hospitalization
ED
None of the aboveOutpatientAlive
Dead
Box A.  RSV Infection
Adverse
EventsSystemic Reaction
Injection Site Reaction
None of the aboveSerious Adverse EventGuillain Barre Syndrome
Methods: Decision Tree Model
10No
Vaccination
VaccinationInfection Hospitalization
ED
None of the aboveOutpatientAlive
Dead
Box A.  RSV Infection
Adverse
EventsSystemic Reaction
Injection Site Reaction
None of the aboveSerious Adverse EventInfection Box A. RSV Infection in each node : same
structure as above, but with risks reduced,
according to vaccine effectiveness
Guillain Barre Syndrome
Annual RSV incidence
•At least one chronic medical condition (source RSV -NET and the Behavioral Risk Factor
Surveillance System [BRFSS]):
•Chronic obstructive pulmonary disease (COPD), OR
•Asthma, OR
•Coronary artery disease (CAD), OR
•Diabetes mellitus, OR
•Chronic kidney disease (CKD), OR
•Severe obesity (body mass index [BMI] ≥40 kg/m2)
•Additional chronic medical conditions evaluated in scenario analyses:
•Heart failure1
•Immune compromised
•Lung transplant2
•Hematopoietic cell transplant, allogeneic3,4
•Hematopoietic cell transplant, autologous3,4
1. Kujawski  SA, et al. Rates of respiratory syncytial virus (RSV) -associated hospitalization among adults with congestive heart failure -United States, 2015 -2017. PLoS  One. 2022 Mar
9;17(3):e0264890. doi: 10.1371/journal.pone.0264890
2. Testaert  H, et al. Incidence, management and outcome of respiratory syncytial virus infection in adult lung transplant recipients: a 9 -year retrospective multicentre  study. Clin Microbiol
Infect. 2021 Jun;27(6):897 -903. doi: 10.1016/j.cmi.2020.07.050.
3. Martino R, et al. Prospective study of the incidence, clinical features, and outcome of symptomatic upper and lower respirato ry tract infections by respiratory viruses in adult
recipients of hematopoietic stem cell transplants for hematologic malignancies. Biol Blood Marrow Transplant. 2005 Oct;11(10) :781-96. doi: 10.1016/j.bbmt.2005.07.007
4. Waghmare A, et al. Supplemental Oxygen -Free Days in Hematopoietic Cell Transplant Recipients With Respiratory Syncytial Virus. J  Infect Dis. 2017 Dec 5;216(10):1235 -1244. doi:
10.1093/ infdis /jix390These conditions  are considered separately
because RSV epidemiologic parameters were
derived from different published sources and
cannot be combined with RSV -NET hospitalization
rate estimates under “at least one” condition.
11
Annual RSV incidence
•At least one chronic medical condition (source RSV -NET and the Behavioral Risk Factor
Surveillance System [BRFSS]):
•Chronic obstructive pulmonary disease (COPD), OR
•Asthma, OR
•Coronary artery disease (CAD), OR
•Diabetes mellitus, OR
•Chronic kidney disease (CKD), OR
•Severe obesity (body mass index [BMI] ≥40 kg/m2)
•Additional chronic medical conditions evaluated in scenario analyses:
•Heart failure1
•Immune compromised
•Lung transplant2
•Hematopoietic cell transplant, allogeneic3,4
•Hematopoietic cell transplant, autologous3,4
121. Kujawski  SA, et al. Rates of respiratory syncytial virus (RSV) -associated hospitalization among adults with congestive heart failure -United States, 2015 -2017. PLoS  One. 2022 Mar
9;17(3):e0264890. doi: 10.1371/journal.pone.0264890
2. Testaert  H, et al. Incidence, management and outcome of respiratory syncytial virus infection in adult lung transplant recipients: a 9 -year retrospective multicentre  study. Clin
Microbiol  Infect. 2021 Jun;27(6):897 -903. doi: 10.1016/j.cmi.2020.07.050.
3. Martino R, et al. Prospective study of the incidence, clinical features, and outcome of symptomatic upper and lower respirato ry tract infections by respiratory viruses in
adult recipients of hematopoietic stem cell transplants for hematologic malignancies. Biol Blood Marrow Transplant. 2005 Oct; 11(10):781 -96. doi:
10.1016/j.bbmt.2005.07.007
4. Waghmare A, et al. Supplemental Oxygen -Free Days in Hematopoietic Cell Transplant Recipients With Respiratory Syncytial Virus. J  Infect Dis. 2017 Dec 5;216(10):1235 -1244. doi:
10.1093/ infdis /jix390Assumed that vaccine effectiveness
was reduced by half  in immune
compromised populations, compared
with all others
Vaccine effectiveness (VE) of a single dose over time:
protein subunit RSV vaccine (combined Pfizer/GSK)
13Linear decay to
0% by 36 months
VE against hospitalization and emergency department visits was assumed to be equal to results of a meta -analysis of observational V E estimates from CDC, FDA/CMS, Veteran’s
Health Administration, and Pfizer analyses from the first RSV season of vaccine availability. VE against outpatient illness w as assumed to be the mean across the two products of
trial efficacy against RSV acute respiratory illness.3-year projected effectiveness against ED and hospitalization based
on a meta -analysis of real -world vaccine effectiveness studies. Base
case truncated at 36 months based on available clinical follow -up
extending only through 3 RSV seasons for a subunit vaccine.
68%
39%78%
59%
45%82%
62%
48%
0%10%20%30%40%50%60%70%80%90%100%
0 6 12 18 24 30 36Effectiveness
Months since vaccination
Outpatient ED Hospitalization
Unlike for protein subunit RSV vaccines, there are
still no published vaccine effectiveness results for
Moderna’s mRNA RSV vaccine.
All effectiveness assumptions in this model are
derived from clinical trial efficacy against
symptomatic disease. Median clinical trial follow up
does not extend beyond 2 years per participant.
14
Vaccine effectiveness (VE) of a single dose over time
base case : mRNA Moderna RSV vaccine ( mRESVIA )
15Linear decay to 0% by
24 months
VE against emergency department visits and hospitalization was assumed to be equal to clinical trial vaccine efficacy against  RSV lower respiratory tract disease with ≥2
signs/symptoms. VE against outpatient illness was assumed to be equal to clinical vaccine efficacy against medically attended  RSV acute respiratory illness. VE was assumed to
decline to zero by month 24 post -vaccination.2-year projected effectiveness based on trial efficacy data through 24
months of follow -up (no real -world effectiveness data exists).
Duration of protection may extend beyond 24 months, but base case
truncated at 24 months based on available clinical follow -up
extending only through a median of <24 months per participant.
68%
44%84%
38%
30%
0%10%20%30%40%50%60%70%80%90%100%
0 6 12 18 24 30 36Effectiveness
Months since vaccination
Outpatient ED and Hospitalization
Vaccine effectiveness (VE) of a single dose over time
scenario analysis : mRNA Moderna RSV vaccine ( mRESVIA )
3-year projected effectiveness based on waning model developed
by Moderna  using clinical trial efficacy at multiple time points (no
real -world effectiveness data exists). In this model effectiveness is
projected to extend for 3 RSV seasons.
Orange line: VE: RSV -LRTD
Blue line: VE: RSV -ARD
Moderna performed a weighted least square regression on VE data estimated every 2 months, through 18 months68%84%
0%10%20%30%40%50%60%70%80%90%100%
0 6 12 18 24 30 36Effectiveness
Months since vaccination
Outpatient ED and Hospitalization
16
Methods Updates
Same model presented in June 2024 and October 2024, with the
following changes:
•Costs
•Costs for those under 65 based on an analysis using MarketScan  by Averin  et al.
•Marketscan  (all of US)
•Matched adults 18+, also reports by chronic condition
•Averin  et al analysis was conducted using final support from Pfizer Inc
•Costs for those 65 and older based on a CDC analysis of Medicare data
•Corrected productivity calculation for ages 50 -64
•Vaccine Effectiveness
•Subunit 36 months of efficacy
•Moderna long -term efficacy assumption
•Mortality
•Guillain Barre Syndrome (GBS)
Averin  A, Atwood M, Sato R, Yacisin  K, Begier  E, Shea K, Curcio D, Houde  L, Weycker  D. Attributable Cost of Adult Respiratory Syncytial Virus Illness Beyond the Acute Phase. In
Open Forum Infectious Diseases 2024 Mar (Vol. 11, No. 3, p. ofae097). US: Oxford University Press.17
Guillain -Barre Syndrome (protein subunit
vaccines only)
•Base: FDA analysis of adults 65+ with rates ranging between 0 – 18 excess
cases per million doses administered
•Scenario:
•Baseline GBS rates in U.S. adults 50 -64 (assumed same for adults 50 -59 in the model)
•25.2 per million person -years (combined male, female)
•2021 study of 50 million person -years of observation1
•Inpatient and emergency department results, adjusted downward by the positive predictive
value (55%) of ICD codes in identifying “true” GBS in inpatient/ED.
•Relative measures of GBS risk from protein subunit RSV vaccination applied relative to
the assumed 50 -59 baseline to see what happens if risk is lower in younger adults2
•GSK: Incidence rate ratio (IRR) = 2.46 (95% CI 1.19 – 5.08)
•Pfizer: IRR = 2.02 (95% CI 0.93 – 4.40)
•42-day risk window used in FDA’s analysis.
•Net Excess 42 -day risk of 3.6 per million doses (average of Pfizer and GSK)
1. Shui IM, Rett MD, and Weintraub E et al. Guillain -Barré syndrome incidence in a large United States cohort (2000 -2009).
Neuroepidemiology. 2012;39(2):109 -15. doi: 10.1159/000339248. Epub  2012 Jul 28. PMID: 22846726.
2. Package inserts: GSK, Pfizer.18
Methods: Additional Inputs
•Also included
•RSV illness QALYs lost
•RSV illness productivity costs
•Vaccination healthcare and productivity costs
•Vaccination adverse events
•Medical costs
•Productivity costs
•These assumptions remain unchanged from October 2024
19Hutton, 2023. “Economic Analysis of RSV Vaccination in Older Adults”. June 2023 ACIP Meeting
Hutton et al., 2024. “Cost -effectiveness of vaccinating adults aged 60 years and older against respiratory syncytial virus”. Vaccine
42(24): 126294
Methods: Scenarios
•Manufacturer -specific (Pfizer and GSK -specific models; Moderna
is considered separately in the base case, so no scenario needed)
•For Moderna, assuming longer duration of protection
(manufacturer 3 -year efficacy assumption)
•Vaccination of persons without chronic medical conditions
•Condition -specific (e.g., vaccination of persons with heart failure)
•Public sector prices for each vaccine (Federal Supply Schedule
prices from the Veterans Health Administration*), rather than the
manufacturer list price
20 *https://www.vendorportal.ecms.va.gov/NAC/Pharma/List
Results
21
Previous (June 2024)  Cost -Effectiveness Results: Societal
costs per quality -adjusted life year (QALY) gained
PreF  subunit vaccines PreF  mRNA vaccines
Adults aged 50 -59
 years  with at least
 1 condition$154,501*
Adults aged 60 -74
 years with at least 1
 condition$60,933 $80,953
All adults aged ≥75
 years $51,447 $66,287 2-year 2-year
At least one condition refers to: chronic obstructive pulmonary disease, asthma, coronary artery disease, diabetes
mellitus, chronic kidney disease, severe obesity (body mass index [BMI] ≥40)
*The $154,501 incremental cost -effectiveness ratio (ICER) is GSK -specific, but the other two are for subunit in
general. 22
Today’s  Cost -Effectiveness Results:
Societal costs per quality -adjusted life year (QALY) gained
PreF subunit vaccines PreF  mRNA vaccines PreF  mRNA vaccines
Adults aged 50 -59
 years  with at least
 1 condition$43,070
(<0-$266,769)$152,293
($1,154 -$811,138)$95,182
(<0-$682,508)
Adults aged 60 -74
 years with at least 1
 condition$21,721
(<0-$120,989)$85,781
($3,368 -$409,467)$50,864
($3,668 -$249,938)
All adults aged ≥75
 years$45,769
($25,505 -$84,871)$100,571
($58,277 -$225,885)$70,731
($42,069 -$159,451)3-year 2-year 3-year
At least one condition refers to: chronic obstructive pulmonary disease, asthma, coronary artery disease,
diabetes mellitus, chronic kidney disease, severe obesity (body mass index [BMI] ≥40)
Ranges reflect 2.5th and 97.5th percentile from Monte Carlo simulation.
“<0” represents cost -saving (lower costs, improved health/QALYs) 23
Outcome Subunit
(3-year)mRNA
(2-year)mRNA
(3-year)
Outpatient 43 56 62
Hospitalization 510 933 681
Death 7,985 14,620 10,675 Number Needed to Vaccinate to Prevent One Outpatient Visit,
Hospitalization, or Death
Age 50 -59 years with at least one condition
At least one condition refers to: chronic obstructive pulmonary disease, asthma, coronary artery disease,
diabetes mellitus, chronic kidney disease, severe obesity (body mass index [BMI] ≥40)
24
Scenario Analyses
25
Scenario:  Cost -Effectiveness Results Using Veterans
Affairs (VA) Federal Supply Schedule (FSS) Vaccine Prices:
Societal costs per quality -adjusted life year (QALY) gained
Subunit RSV
vaccinePreF  mRNA vaccines PreF  mRNA vaccines
Adults aged 50 -59
 years  with at least
 1 condition$25,967 $79,443 $37,082
Adults aged 60 -74
 years with at least 1
 condition  $12,122   $43,670  $18,380
All adults aged ≥75
 years
 $37,536  $64,251 $42,8823-year 2-year 3-year
VA Federal Supply Schedule prices used in lieu of list prices ( VA National Acquisition Center Contract Catalog Search Tool ): Arexvy  (GSK)
$263, Abrysvo  (Pfizer) $258, mResvia  (Moderna) $204.
At least one condition refers to: chronic obstructive pulmonary disease, asthma, coronary artery disease, diabetes mellitus, chronic kidney disease,
severe obesity (body mass index [BMI] ≥40)26
$0 $25,000 $50,000 $75,000 $100,000 $125,000 $150,000 $175,000 $200,000
All Adults
At least one condition
 CKD
 COPD
 obesity BMI >40
 Asthma
 CAD
 Diabetes
 Heart Failure
With lung transplant
With allogenic HCT
With autologous HCTIncremental cost per QALY gained
 50-59
 60-74
≥75
not age-specificSpecific Chronic Conditions: Subunit
CKD: chronic kidney disease; COPD: chronic obstructive pulmonary disease; BMI: body mass index; CAD: coronary artery disease;  HCT: hematopoietic cell transplant
*Indicates cost saving which means net costs are reduced and health outcomes are improved when compared to “no vaccination ”
At least one condition refers to: COPD, asthma, CAD, diabetes mellitus, CKD, severe obesity (BMI ≥40)*****
27**
*
**
*
**
*
**Severe obesity (BMI ≥ 40)
Heart failure
Specific Chronic Conditions: mRNA (2 -year)
CKD: chronic kidney disease; COPD: chronic obstructive pulmonary disease; BMI: body mass index; CAD: coronary artery disease;  HCT: hematopoietic cell transplant
*Indicates cost saving which means costs are reduced and health outcomes are improved
At least one condition refers to: COPD, asthma, CAD, diabetes mellitus, CKD, severe obesity (BMI ≥40)*
*
28**$0 $25,000 $50,000 $75,000 $100,000 $125,000 $150,000 $175,000 $200,000
All Adults
At least one condition
 CKD
 COPD
 obesity BMI >40
 Asthma
 CAD
 Diabetes
 Heart Failure
With lung transplant
With allogenic HCT
With autologous HCTIncremental cost per QALY gained
 50-59
 60-74
≥75
not age-specificSevere obesity (BMI ≥ 40)
Heart failure
Specific Chronic Conditions: mRNA (3 -year)
CKD: chronic kidney disease; COPD: chronic obstructive pulmonary disease; BMI: body mass index; CAD: coronary artery disease;  HCT: hematopoietic cell transplant
*Indicates cost saving which means costs are reduced and health outcomes are improved
At least one condition refers to: COPD, asthma, CAD, diabetes mellitus, CKD, severe obesity (BMI ≥40)*
*
29***
**
***$0 $25,000 $50,000 $75,000 $100,000 $125,000 $150,000 $175,000 $200,000
All Adults
At least one condition
 CKD
 COPD
 obesity BMI >40
 Asthma
 CAD
 Diabetes
 Heart Failure
With lung transplant
With allogenic HCT
With autologous HCTIncremental cost per QALY gained
 50-59
 60-74
≥75
not age-specificSevere obesity (BMI ≥ 40)
Heart failure
Hospitalizations, ICU stays, and deaths preventable
if 20% of all U.S. adults aged 50 -59 years with at
least one chronic condition* were vaccinated
The model assumed 0–48 cases of Guillain -Barre Syndrome total
305,219
1,148
3331,793
394 8910,077
2,217
702
02,0004,0006,0008,00010,00012,000
Hospitalizations ICU Stays DeathsEvents Preventable
*At least one condition refers to: chronic obstructive pulmonary disease, asthma, coronary artery disease, diabetes mellitus,  chronic kidney disease,
severe obesity (body mass index [BMI] ≥40)
Scenario (lower GBS risk in adults aged <65)*: Hospitalizations,
ICU stays, and deaths preventable if 20% of all U.S. adults aged
50-59 years with at least one chronic condition** were vaccinated
The model assumed 1 –29 cases of Guillain -Barre Syndrome total
*Assuming lower baseline risk of GBS in adults aged 50 -59 years than in adults aged ≥65 years. In this scenario, the relative risk of GBS
was applied to published background rates of GBS for this age group.
**At least one condition refers to: chronic obstructive pulmonary disease, asthma, coronary artery disease, diabetes mellitus, chronic
kidney disease, severe obesity (body mass index [BMI] ≥40)
 315,219
1,148
3331,793
394 8910,077
2,217
702
02,0004,0006,0008,00010,00012,000
Hospitalizations ICU Stays DeathsEvents Preventable
Limitations
•Model Structure
•No dynamic transmission. No impact of the vaccine on transmission and
indirect effects
•We did not include or analyze all potential RSV risk factors.
•Some medical conditions (e.g., interstitial lung disease) are likely associated with
high risk of severe RSV disease, but literature on population -based hospitalization
rates and other outcomes are lacking.
•Uncertain inputs
•RSV burden of disease, especially hospitalization and mortality
•RSV costs
•Caregivers of persons ill with RSV may incur additional productivity losses not included
in this model
•Duration and waning pattern of vaccine protection (especially mRNA)
32
Conclusions
•Cost -Effectiveness of vaccinating adults 50-59 with at least one
chronic medical condition:
•Subunit: $43,070/QALY
•mRNA: $152,293/QALY (2 -year), $95,182/QALY (3 -year)
•Vaccinating people with th e following conditions may be cost -saving:
•Immune compromise, defined as hematopoietic cell transplant or lung transplant
•Heart failure
•Chronic obstructive pulmonary disease (COPD)
•Chronic kidney disease
•Severe obesity (body mass index [BMI] ≥40)
•Scenarios with lower prices were more cost -effective
33
Thank You
•Please send questions/comments to:
•dwhutton@umich.edu
34

Summary: This slide deck was prepared by Dr. David Hutton  of the University of Michigan and reflects his work.  It is being presented by CDC staff on his behalf. Dr.  Hutton will be available to answer questions at the  end of this presentation.  1 Economic Analysis of Protein Subunit  and mRNA RSV Vaccination in Adults  aged 50 -59 Years David W. Hutton, PhD, MS Associate Professor, Health Management and Policy, School of Public Health Associate Professor of Global Public Health, School of Public…


05 Ortega Sanchez Adult RSV 508

Economics of Respiratory Syncytial Virus
Vaccination in Adults aged 50 -59 years
at Increased Risk of Severe RSV Disease
SUMMARY COMPARING MODELS FROM:
GSK,Moderna ,Pfizer AND University of Michigan -CDC
Ismael R. Ortega -Sanchez, PhD
NCIRD/CDC
ACIP Meeting, April 16, 2025
1Disclaimer : The findings and conclusions in this report are those of the authors and do not necessarily represent the views of
the Centers for Disease Control and Prevention.
Conflicts of interest
•GSK model : David Singer et al.,  [complete list and affiliations, upon request]
•GSK manufactures the adjuvanted RSVPreF3 (RSVPreF3)  vaccine
•RTI Health Solutions was funded by GSK
•Moderna model : Parinaz  Ghaswalla  et al., [complete list and affiliations, upon request]
•Moderna manufacturers the mRNA -1345 RSV  vaccine
•Quadrant Health Economics and RTI Health Solutions were funded by Moderna
•Pfizer  model : Reiko Sato et al., [complete list and affiliations, upon request]
•Pfizer Inc (PA, USA) manufacturers the bivalent stabilized prefusion F subunit ( RSVpreF ) vaccine
•Avalere Health (Washington DC, USA) was funded by Pfizer
•UM-CDC model : David W Hutton et al. from Univ Michigan, …, Ismael R Ortega -Sanchez et al. from CDC
[complete list and affiliations, upon request ]
•All authors: No conflicts of interest
2
Economic analysis
Policy question : Should a single dose of RSV vaccine (any licensed product)a,b be
recommended for adults 50 -59 years old at increased risk of severe RSV disease?
Cost -effectiveness analyses :
               Comparator      Intervention
Base -case scenario:
•What is the incremental cost-effectiveness  of vaccinating adults aged 50 -59 years
at increased risk of severe RSV disease relative to no vaccination?
3No vaccinationVaccination:
Receipt of one dose of any
licensed RSV vaccine
a. GSK and Pfizer vaccines are currently licensed for adults 50 -59 years at increased risk: https://www.fda.gov/vaccines -blood -
biologics/arexvy , https://www.fda.gov/vaccines -blood -biologics/abrysvo
b. Moderna vaccine is not currently licensed in adults aged <60 years: https://www.fda.gov/vaccines -blood -biologics/vaccines/mresvia
4Modeling design and assumptions
GSK Moderna Pfizer UM-CDC
Static analytical decision -making models
Sensitivity analyses (and probabilistic simulation)
 (
)
 (
)
 (
)
 (
)
Hypothetical population: 50 -59 years old at increased risk
Timeframe after a dose of RSV vaccine (in years)a 5 3 3.5b 3 and 2c
Analytic Horizon: Age - and comorbidity -specific life expectancy
 Age only
Discount rate: 3%
Year of economic outcomes measured 2024 2024 2023 2024
Societal perspective (and healthcare perspective)
 (
)
 (
)
 (
)
 (
)
a.Base -case in Moderna, and Pfizer models relied on a three -year timeframe (other timeframes included in scenario analyses) while GSK used a five -year timeframe in the base -case and
three -year in scenario. In each model, selection of timeframe is based on the duration of protection assumption.
b.Although Pfizer base -case relies on a thee -year timeframe, in scenario analyses Pfizer reported outcomes for up to 70 months (>5  years timeframe) duration of vaccine protection.
c.Base -case in UM -CDC model uses three -year time frame for protein subunit vaccines and a two -year time frame for mRNA vaccine.  However, in a scenario analysis UM -CDC model
uses a three -year time frame for the mRNA vaccine
GSK, Moderna , Pfizer  and UM-CDC models
comparison
We will compare:
•Risk conditions included in base -case and scenarios
•Incidence of RSV hospitalization and outpatient care
•Medical costs due to RSV illness
•RSV mortality rate
•Indirect costs due to RSV illness
•Quality -adjusted life years lost per RSV illness
•Initial vaccine effectiveness and waning assumptions
51st
2nd
3rd
4th
GSK, Moderna , Pfizer  and UM-CDC models comparison:
Risk conditions included in base -case and scenarios
6GSK Moderna Pfizer  UM-CDC
Base -caseChronic obstructive
pulmonary disease
(COPD)≥ 1 chronic medical
conditiona≥ 1 chronic or
immunocompromising
medical conditionb≥ 1 chronic medical
conditionc
Individual
conditions
evaluated in
scenarios•Asthma
•Congestive heart failure
•Coronary artery disease
•Diabetes mellitus•Asthma
•COPD
•Coronary artery disease
•Congestive heart failure
•Chronic kidney disease
•Chronic liver disease
•Diabetes mellitus
•Severe obesity (body
mass index [BMI] ≥40
kg/m2)•Cardiovascular disease
•Pulmonary disease
•Renal disease
•Diabetes mellitus
•Immunocompromising
conditions (e.g., solid cancer,
hematological malignancies,
solid organ transplant, or
receiving immunosuppressive
medication)•Asthma
•COPD
•Coronary artery disease
•Chronic kidney disease
•Diabetes mellitus
•Severe obesity (BMI ≥40
kg/m2)
•Heart failure
•Lung transplant
•Allogeneic hematopoietic
cell transplant
•Autologous hematopoietic
cell transplant
a.Moderna model: “≥ 1 chronic medical condition” included asthma, COPD, coronary artery disease, congestive heart failure, chro nic kidney disease, chronic liver disease, diabetes mellitus, ,
and severe obesity.
b.Pfizer model: “≥ 1 chronic or immunocompromising medical condition” included cardiovascular disease, hematologic disease, hep atic disease, metabolic disorders, pulmonary disease, renal
disease, severe obesity (BMI ≥40 kg/m2), and immunocompromising conditions.
c.University of Michigan -CDC model: “≥ 1 chronic medical condition” included asthma, COPD, coronary artery disease, chronic kidney  disease, diabetes mellitus, and severe obesity (BMI ≥40
kg/m2).
7UM-CDC GSK
Incidence of RSV outpatient illness
(per 100,000 persons per year)2,940 for adults 50 -59 years with cardiopulmonary
disease (e.g., COPD) a
1,722  for adults 50 -59 years with other chronic
condition (e.g., diabetes mellitus) a2,926
for adults 50 -59 years with COPD a
Incidence of RSV hospitalization
(per 100,000 persons per year)106 for adults 50 -59 years with ≥1 chronic
condition b
169 for adults 50 -59 years with COPD, specifically b311
for adults 50 -59 years with COPD c
Medical costs per RSV hospitalization
$40,439 ($32,352 –$48,527)d $30,774
(range +/ - 20% )e
Medical costs per RSV ED visit and
per RSV Outpatient visit$5,235 ($4,188 –$6,282)d
$586 ($469 –$704)d$884  (range +/ - 20%)f
$256 (range +/ - 20%)f
a.Adapted from Belongia  et al. Open Forum Infect Dis (2022). https://pubmed.ncbi.nlm.nih.gov/30619907/ . Adjusted upward by a factor of 1.5 for diagnostic test sensitivity in detecting RSV
infection (McLaughlin et al. [2022]) https://pubmed.ncbi.nlm.nih.gov/35873302/
b.CDC unpublished data, updates to analysis presented to ACIP (Woodruff, February 2024: https://www.cdc.gov/acip/downloads/slides -2024 -02-28-29/03 -RSV-Adults -Woodruff -508.pdf ).
c.Adapted from Branche et al. (2022), https://pubmed.ncbi.nlm.nih.gov/34244735/  across Rochester and New York City sites adjusted by a factor of 1.5 for diagnostic test sensitivity in
detecting RSV infection (McLaughlin et al. [2022]) https://pubmed.ncbi.nlm.nih.gov/35873302/
d.For the general population, adjusted according to results for adults with and without chronic conditions. Averin  et al. (2024) https://pubmed.ncbi.nlm.nih.gov/38486815/
e.CMS Medicare Inpatient Hospitals - by Geography and Service (CMS, 202 4); (DRG Average Payments from 2022 dataset); Falsey  et al. (2005) https://pubmed.ncbi.nlm.nih.gov/15858184/
f.CMS.gov Hospital Outpatient Prospective Payment (CMS, 2024). Average of CPT 99283 and 99284.  Added is the physician fee from  CMS.gov Physician Fee Lookup Tool (CMS, 2024). Average
of CPT 99283 and 99284. https://www.cms.gov/medicare/payment/prospective -payment -systems/hospital -outpatient/regulations -notices/cms -1786 -fc UM-CDC and GSK models:  Incidence and medical
costs of RSV hospitalization and outpatient care
8UM-CDC Moderna
Incidence of RSV outpatient illness
(per 100,000 persons per year) 1,722  for adults 50 -59 years with  ≥1 chronic
conditiona2,322  for adults 50 -59 years with ≥1
conditions and
964 for adults 50 -59 years,
without chronic conditionsb
Incidence of RSV hospitalization
(per 100,000 persons per year)106 for adults 50 -59 years with ≥ 1 chronic
condition c 217.9  for adults 50 -59 years with ≥1
conditions b
Medical costs per RSV hospitalization$40,439
($32,352 – $48,527) e $11,876
($8,407 - $47,512)f
Medical costs per RSV ED visit and
per RSV Outpatient visit$5,235 ($4,188 – $6,282)  e
$586 ($469 – $704) e$4,399 ( no range ) d, g
$2,273 ( no range ) f
a. Adapted from Belongia  et al. Open Forum Infect Dis (2022). https://pubmed.ncbi.nlm.nih.gov/30619907/ . Adjusted upward by a factor of 1.5 for diagnostic test sensitivity in detecting RSV infection
(McLaughlin et al. [2022]) https://pubmed.ncbi.nlm.nih.gov/35873302/
b. Adjusted by 1.5x for PCR test sensitivity. Adapted from McLaughlin et al. Open Forum Infect Dis (2022), https://pubmed.ncbi.nlm.nih.gov/30619907/  and Weycker  (2024),
https://pubmed.ncbi.nlm.nih.gov/38236516/  using methods applied in Averin  (2024), https://pubmed.ncbi.nlm.nih.gov/38486815/
c. CDC unpublished data, updates to analysis presented to ACIP (Woodruff, February 2024: https://www.cdc.gov/acip/downloads/slides -2024 -02-28-29/03 -RSV-Adults -Woodruff -508.pdf ).
d. Averin  et al. (2024) Supplemental Table 3 https://pubmed.ncbi.nlm.nih.gov/38486815/
e. For the general population, adjusted according to results for adults with and without chronic conditions. Averin  et al. (2024) https://pubmed.ncbi.nlm.nih.gov/38486815/
f. Wyffels  et al. (2020), https://pubmed.ncbi.nlm.nih.gov/32026380/  (Moderna’s technical report provides inpatient cost ranges based on assumptions and supported by other studies)
g. Merative  MarketScan  Commercial Claims and Encounters (CCAE) and Medicare Supplemental Coordination of Benefits (MDCR) Databases (2016 -2019)UM-CDC and Moderna  models:  Incidence and
medical costs of RSV hospitalization and outpatient care
9UM-CDC Pfizer
Incidence of RSV outpatient illness
(per 100,000 persons per year)1,722  for adults 50 -59 years with ≥1 chronic
medical condition (e.g., diabetes mellitus) a3,158
for adults 50 -59 years with ≥1 condition b
Incidence of RSV hospitalization
(per 100,000 persons per year)106 for adults 50 -59 years with ≥ 1 chronic
condition c 367
for adults 50 -59 years with ≥1 condition b
Medical costs per RSV hospitalization$40,439
($32,352 – $48,527) d $40,361
(no range reported)e
Medical costs per RSV ED visit and
per RSV Outpatient visit$5,235 ($4,188 – $6,282)  d
$586 ($469 – $704) d$6,168  ( no range reported ) d, e
$933 ( no range reported ) d, e
a.Adapted from Belongia  et al. Open Forum Infect Dis (2022). https://pubmed.ncbi.nlm.nih.gov/30619907/ . Adjusted upward by a factor of 1.5 for diagnostic test sensitivity in detecting RSV
infection (McLaughlin et al. [2022]) https://pubmed.ncbi.nlm.nih.gov/35873302/
b.Adapted from McLaughlin et al. (2022), https://pubmed.ncbi.nlm.nih.gov/35873302/ ; Weycker  et al. (2024), https://pubmed.ncbi.nlm.nih.gov/38236516/ ; Ramirez et al. (2023),
https://pubmed.ncbi.nlm.nih.gov/37148463/ ; Onwuchekwa et al. (2023), https://pubmed.ncbi.nlm.nih.gov/36661222/ . Age and risk group is 50 -64 years  with selected chronic or
immunocompromising medical conditions.
c.CDC unpublished data, updates to analysis presented to ACIP (Woodruff, February 2024: https://www.cdc.gov/acip/downloads/slides -2024 -02-28-29/03 -RSV-Adults -Woodruff -508.pdf ).
d.For the general population, adjusted according to results for adults with and without chronic conditions. Averin  et al. (2024) https://pubmed.ncbi.nlm.nih.gov/38486815/
e.Averin  et al (2024) , https://doi.org/10.1093/ofid/ofae097  .UM-CDC and Pfizer  models:  Incidence and
medical costs of RSV hospitalization and outpatient care
GSK, Moderna , Pfizer  and UM-CDC models:
Mortality, indirect costs and quality -adjusted life -years
10GSK Moderna Pfizer  UM-CDC
Mortality
(case fatality
ratio, CFR)7.0%  CFR among COPD
hospitalized for RSV -LRTD4.3%  CFR among hospitalized 4.7%  CFR among hospitalized
50-64y CMC+6.4 deaths per 100 RSV
hospitalizations, inclusive of
deaths among non -
hospitalized persons
Indirect costs
(productivity
losses)Premature death
      Market:
50-54 years: $871,542
55-59 years: $601,091
Nonmarket:
50-54 years: $691,270
55-59 years: $621,604
Days of work lost
Inpatient care: 15.18
ED/Outpatient care: 4.30
No treatment: 0.50Premature death
Not included in their analyses
Days of work lost
Inpatient care: 7.53
ED care: 3.30
Outpatient care: 2.30
Presenteeism: 1 day all cases
Caregiver: 0.75x patient’s timePremature death
50-59 years with CMC+:
$333,915
Days of work lost
Inpatient care: 10
ED/Outpatient care: 5
Caregiver: 0.50x patient’s timePremature death
Age-specific annual mortality
and life expectancy from life
tablesa multiplied by market
and non -market foregone
income and discounted at 3%
per year
Days of work lost
Inpatient care:  8
ED/Outpatient care: 2.50
QALY LossRSV-URTD 0.0133
RSV-LRTD  0.0178  ED/Outpatient 0.0185
       Inpatient    0.0193
  No treatment 0.0093ED/Outpatient 0.0054
           Inpatient 0.0167Outpatient  0.0185
Inpatient  0.0193
a. Vital Statistics Reports. National Vital Statistics Reports Vol 71, No 1, August 8, 2022. United States Life Tables, 2020. Pu b. online 2022. Accessed March 7, 2025. https://www.cdc.gov/nchs/products/index.htm
Abbreviations : COPD= chronic obstructive pulmonary disease, LRTD= lower respiratory tract disease, CFR= case fatality ratio, ED= Emergency d epartment, CMC+= selected chronic or immunocompromising
medical conditions, QALY= quality -adjusted life -year
42 48 54 60
GSK (RSVPreF3) and UM-CDC (subunit): Modeled vaccine
effectiveness and duration of protection per outcome
11
The pink -shaded area denotes a higher level of uncertainty of the waning assumption
a. Three -year projected effectiveness against ED and hospitalization based on a meta -analysis of real -world vaccine effectiveness s tudies. Base case truncated at 36
months based on available clinical follow -up extending only through three RSV seasons for a subunit vaccineGSKSource : La EM, et al..
Hum Vaccin
Immunother . 2024
Dec
31;20(1):2432745.
https://doi.org/10.1
080/21645515.2024.
2432745
LRTD= Lower
respiratory tract
disease, ARI = acute
respiratory infectionSource : UM -CDC
is based on
Hutton et al.
ACIP
presentation
(Apr 2025) and
on an
unpublished
manuscriptUM-CDCa
42 48 54 60
84.6%
65.1%72.0%
47.0%____
Outpatient visit
(PO/HO)
____
Hospitalization
(including ICU &
death) and EDPfizerb
12Pfizer (RSVpreF ) and UM-CDC (subunit): Modeled vaccine
effectiveness and duration of protection per outcome
UM-CDCa
The pink -shaded area denotes a higher level of uncertainty of the waning assumption beyond available phase 3 data
a.UM-CDC: Three -year projected effectiveness against ED and hospitalization based on a meta -analysis of real -world vaccine effecti veness studies. Base case truncated at 36
months based on available clinical follow -up extending only through three RSV seasons for a subunit vaccine
b.Pfizer model: Base -case vaccine effectiveness against RSV -Hospital and RSV -ED corresponding to the solid blue line was applied. The dotted blue line reflects vaccine
effectiveness against RSV -Hospital and RSV -ED if the waning pattern would persist.Source : Pfizer
Technical report
and Slides
submitted to
CDC  (2024 and
January 2025)
ICU = Intensive
care unit, ED=
Emergency
department,
PO= physician
office, HO =
hospital
outpatientSource : UM -
CDC is based on
Hutton et al.
ACIP
presentation
(Apr 2025) and
on an
unpublished
manuscript
Moderna  and UM-CDC: Modeled vaccine
effectiveness and duration of protection per outcome
13UM-CDCa (two-year timeframe: solid lines )
Scenario:  3-year timeframe linear decay, 0% at 36 months: dotted lines
The pink -shaded areas denote a higher level of uncertainty of the waning assumption beyond available phase 3 data
a.UM-CDC base case truncated at 24 months based on available clinical follow -up extending only through a median of <24 months per participant
   Source: for Moderna, Moderna's technical report (2025) and for UM -CDC, Hutton et al., ACIP Presentation (Apr 2025) Moderna  (three -year timeframe )
ARD = Acute respiratory disease
LRTD =Lower respiratory tract disease
ED = Emergency department86.7%
83.7%
68.4%
____  Vaccine effectiveness for RSV Hospitalization & ED = VE LRTD ≥2 symptoms
____ Vaccine effectiveness for RSV Outpatient= VE medically attended ARD

a.GSK estimated cost -saving values for COPD (base -case) and for each selected individual condition: heart failure, CAD, asthma and di abetes.
b.In the 3 -year timeframe  for a generic protein subunit vaccine effectiveness , UM-CDC estimated a societal cost of $ 43,070/QALY saved  for adults with at least one
chronic condition (COPD, asthma, CAD, CKD, severe obesity, or diabetes) vaccinated with subunit  RSV vaccine. For individual conditions, when vaccinating with a
generic protein subunit RSV vaccine, ICERs ranged from cost -saving (CKD, COPD, BMI ≥40) to $ 57,441  (Diabetes) per QALY saved. When evaluating other specific
conditions not included in “at least one” , $/QALY for adults aged 50 -59 years were also cost -saving (i.e., lung transplant, allogeneic hematopoietic cell transplant, and
autologous hematopoietic cell transplant, heart failure).
Abbreviations : COPD= Chronic obstructive pulmonary disease, CAD=Coronary artery disease, CKD= Chronic kidney disease, ICER= Incremental co st-effectiveness ratio,
BMI = Body mass index, QALY= quality -adjusted life -year Incremental cost -effectiveness:
GSK and UM-CDC
Policy question:  What is the incremental cost-effectiveness  of vaccinating adults aged 50 -59 years
oldat increased risk  of severe RSV illness relative  to “No vaccination”?
14GSK UM-CDC
$/QALY saved ( 3-year
timeframe )Cost -saving (COPD)a $44,203b
For a generic protein subunit RSV vaccine:
•Cost -saving: CKD, COPD, BMI≥40
•$9,889 (Asthma)
•$13,177 (CAD)
•$57,441 (Diabetes)
$/QALY saved ( 5-year
timeframe )Cost -saving (COPD)a
(base -case)Not included
a.Pfizer  model  estimated cost -saving values for selected high -risk conditions: COPD, CAD, CKD, diabetes mellitus, immune compromised an d severe immune compromised.
Base -case used a 3.5 -year vaccine efficacy duration from Phase 3 clinical trials.
b.In the 3 -year timeframe for a generic protein subunit vaccine effectiveness , UM -CDC estimated a societal cost of $ 43,070/QALY saved for adults with at least one chronic condition
(COPD, asthma, CAD, CKD,  severe  obesity , or diabetes ) vaccinated with subunit RSV vaccine. For individual conditions, when vaccinating with a generic protein subunit RSV vaccine, ICERs
ranged from cost -saving (CKD, COPD, BMI>40) to $57,441  (Diabetes) per QALY saved. When evaluating other specific conditions not included in “at least one” , $/QALY for 50-59 years old
were also cost -saving (i.e., lung transplant, allogeneic hematopoietic cell transplant, autologous hematopoietic cell transplant , and heart failure).
Abbreviations : COPD= Chronic obstructive pulmonary disease, CAD=Coronary artery disease, CKD= Chronic kidney disease, ICER= Incremental co st-effectiveness ratio, BMI =
Body mass index, QALY= quality -adjusted life -year Incremental cost -effectiveness:
 Pfizer  and UM-CDC
Policy question:  What is the incremental cost-effectiveness  of vaccinating adults aged 50 -59 years
oldat increased risk  of severe RSV illness relative  to “No vaccination”?
15Pfizera UM-CDCb
$/QALY saved ( 3- to 3.5 -
year timeframe ) base -caseCost saving $41,754
For a generic protein subunit RSV vaccine:
•Cost -saving: CKD, COPD, BMI≥40
•$9,889 (Asthma)
•$13,177 (CAD)
•$57,441 (Diabetes)
$/QALY saved ( 70 months
timeframe scenario )Cost Saving Not included
a.Moderna reported $/QALY of $40,493 (COPD), $64,289 (CLD), $$61,504 (CKD), $83,598 (Diabetes) and $65,125  (severe obesity, BMI≥  40.
b.In the base case (2 -year timeframe), UM -CDC estimated a societal cost of $ 152,293/QALY saved for adults with at least one chronic condition (COPD, asthma, CAD, CKD, severe
obesity, or diabetes). When evaluating other specific conditions not included in “at least one,”  $/QALY reported were cost -saving (i.e., lung transplant, allogeneic hematopoietic
cell transplant, autologous hematopoietic cell transplant, and heart failure ).
Abbreviations : CHF= Congestive heart failure, COPD= Chronic obstructive pulmonary disease, CLD= Chronic liver disease, CAD=Coronary artery  disease, CKD= Chronic kidney disease,
ICER= Incremental cost -effectiveness ratio, BMI = Body mass index, QALY= quality -adjusted life -year Incremental cost -effectiveness:
Moderna  and UM-CDC
Policy question:  What is the incremental cost-effectiveness  of vaccinating adults aged 50 -59 years
oldat increased risk  of severe RSV illness relative  to “No vaccination”?
16Moderna UM-CDC
$/QALY saved ( 2-year
timeframe )$75,862 $152,293 (Base case)b
For individual conditions costs ranged from
$6,052 (CKD) to
$174,454 (Diabetes) per QALY saved
$/QALY saved ( 3-year
timeframe ) $65,125 (Base case)a
For individual conditions costs ranged
from $10,889 (CHF and heart failure) to
$95,606 (Asthma) per QALY saved$95,182
For individual conditions ranged from cost -
saving (CKD) to $114,315 (Diabetes) per
QALY saved
Limitations
17•Factors not considered that may result in underestimating the cost -effectiveness of RSV
vaccination
•Impact of RSV on long -term prognosis of included higher risk conditions
•Indirect effects of vaccination (i.e., protection against RSV transmission)
•Quality -of-life impact on caregivers during RSV illness
•Two models ( GSK, UM-CDC) do not include, and two models (Moderna, Pfizer ) partially include
•Productivity impact (work time missed) on caregivers during RSV illness
•Manufacturer models do not include  RSV-related medical costs incurred after discharge from an RSV -associated
hospitalization or emergency department visit (i.e., stay in long -term care or rehabilitation facility)
•Partially  include potential  vaccine -associated serious adverse events (SAEs) or Guillain Barre syndrome (GBS): Quality
of life impact, resource utilization, and costs associated with SAEs, including GBS specifically for protein subunit RSV
vaccines.
•Duration of vaccine protection beyond clinical trial follow -up time ( beyond median 19 months,
Moderna ; mean 18 months , Pfizer ormedian 31 months ,GSK) is unknown
•All 4 models assumed non -zero declining  efficacy beyond trial time data
•All 4 models assumed optimal timing of vaccination, in the late summer and early fall, prior to
RSV season onset .
Conclusion
18•Differences in key inputs and assumptions among GSK, Moderna , Pfizer  and UM-CDC models
explain differences in results:
•Annual incidence of RSV hospitalization and outpatient disease
•Initial vaccine efficacy/effectiveness and waning of protection assumptions
•Medical cost per RSV hospitalization
•Resulting ICERs for policy question also vary by vaccine type and risk condition
•Vaccinating adults aged 50 -59 years old at increased risk of severe RSV disease  showed disperse
$/QALY ratios
•Assuming 3 years of vaccine protection:
•Outcomes for PreF  combined subunit RSV vaccine ranged from societal cost-saving  (GSK and Pfizer models and
for all included high -risk conditions ) to $43,070  per QALY saved ( UM-CDC, though some high -risk conditions were
reported to be cost -saving)
•Outcomes for PreF  mRNA RSV vaccine ranged from $65,125 ( Moderna ) to $ 95,182 (UM-CDC) per QALY saved
•Overall, vaccination would significantly reduce RSV disease burden in adults 50 -59 years at
increased risk of severe RSV disease.
•Efficacy data from clinical trials from all vaccines as well as conservative assumptions about
duration of protection support impact on disease reduction and health risks
Acknowledgements
From NCIRD/CDC
•Michael Melgar
•Amadea Britton
•Andrew Leidner
•Ruth Link -Gelles
•Allison Ciesla
•Meredith McMorrow
Also:
•Adult RSV working group members
19

Selected references
20Averin  A,  Atwood M, Sato R, et al.  Attributable Cost of Adult Respiratory Syncytial Virus Illness Beyond the Acute Phase, Open For um Infectious Diseases, Volume 11, Issue 3, March
2024, ofae097, https://doi.org/10.1093/ofid/ofae097
Belongia  EA, King JP,  Kieke  BA, et al.  Clinical Features, Severity, and Incidence of RSV Illness During 12 Consecutive Seasons in a Community Cohort of Adults ≥60 Years Old, Open Forum
Infectious Diseases, Volume 5, Issue 12, December 2018, ofy316, https://doi.org/10.1093/ofid/ofy316
Branche AR, Saiman L,  Walsh EE, et al.  Incidence of Respiratory Syncytial Virus Infection Among Hospitalized Adults, 2017 –2020 , Clinical Infectious Diseases, Volume 74, Issue 6, 15
March 2022, Pages 1004 –1011, https://doi.org/10.1093/cid/ciab595
Falsey  AR, Hennessey PA, Formica MA, Cox C, Walsh EE. Respiratory syncytial virus infection in elderly and high -risk adults. N Engl J Med. 2005 Apr 28;352(17):1749 -59. doi:
10.1056/NEJMoa043951. PMID: 15858184. https://doi.org/10.1056/nejmoa043951
Havers FP, Whitaker M, Melgar M, et al. Burden of Respiratory Syncytial Virus -Associated Hospitalizations in US Adults, October 2016 to September 2023. JAMA Netw  Open. 2024 Nov
4;7(11):e2444756. doi: 10.1001/jamanetworkopen.2024.44756. PMID: 39535791; PMCID: PMC11561688. https://doi.org/10.1001/jamanetworkopen.2024.44756
La EM, Graham J, Singer D, et al. Cost -effectiveness of the adjuvanted RSVPreF3 vaccine among adults aged ≥60 years in the Unite d States. Hum Vaccin  Immunother . 2024 Dec
31;20(1):2432745. https://doi.org/ 10.1080/21645515.2024.2432745
Lopez E, Neuman T, Jacobson G, Levitt L. How Much More Than Medicare Do Private Insurers Pay? A Review of the Literature. Kai ser Family Foundation; 2020.  Website,  last visited  Feb
18,2025 https://www.kff.org/medicare/issue -brief/how -much -more -than -medicare -do-private -insurers -pay-a-review -of-the-literature/
M McLaughlin JM, Khan F,  Begier  E, et al.  Rates of Medically Attended RSV Among US Adults: A Systematic Review and Meta -analysis, Open Forum Infectious Diseas es, Volume 9, Issue
7, July 2022, ofac300, https://doi.org/10.1093/ofid/ofac300
Nguyen -Van-Tam JS, O'Leary M, Martin ET, Heijnen  E, Callendret  B, Fleischhackl  R, Comeaux C, Tran TMP, Weber K. Burden of respiratory syncytial virus infection in older and high -risk
adults: a systematic review and meta -analysis of the evidence from developed countries. Eur Respir Rev. 2022 Nov 15;31(166):220105. doi: 10.1183/16000617.0105 -2022. PMID:
36384703; PMCID: PMC9724807. https://doi.org/10.1183/16000617.0105 -2022
Onwuchekwa C, Moreo LM, Menon S, et al. Underascertainment  of Respiratory Syncytial Virus Infection in Adults Due to Diagnostic Testing Limitations: A Systematic Literature Review
and Meta -analysis. J Infect Dis. 2023;228(2):173 -184 https://doi.org/10.1093/infdis/jiad012
Ramirez J, Carrico R, Wilde A, et al. Diagnosis of Respiratory Syncytial Virus in Adults Substantially Increases When Adding Sputum, Saliva, and Serology Testing to Nasopharyngeal Swab
RT PCR. Infect Dis Ther . 2023;12(6):1593 -1603 https://doi.org/10.1007/s40121 -023-00805 -1
Weycker  D, Averin  A, Houde  L, et al. 2207. Rates of Lower Respiratory Tract Infections Among US Adults Aged ≥18 Years With and Without Chronic Medical C onditions. Open Forum
Infectious Diseases. 2022;9(Supplement_2)  https://doi.org/10.1093/ofid/ofac492.1826
Wyffels , V., Kariburyo , F., Gavart , S. et al. A Real -World Analysis of Patient Characteristics and Predictors of Hospitalization Among US Medicare Beneficiaries w ith Respiratory Syncytial
Virus Infection. Adv Ther  37, 1203 –1217 (2020). https://doi.org/10.1007/s12325 -020-01230 -3
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Summary: Economics of Respiratory Syncytial Virus  Vaccination in Adults aged 50 -59 years  at Increased Risk of Severe RSV Disease SUMMARY COMPARING MODELS FROM: GSK,Moderna ,Pfizer AND University of Michigan -CDC Ismael R. Ortega -Sanchez, PhD NCIRD/CDC ACIP Meeting, April 16, 2025 1Disclaimer : The findings and conclusions in this report are those of the authors and do not necessarily represent the views of  the Centers for Disease Control and Prevention.  Conflicts of interest •GSK model : David…