Economics of Vaccinating U.S. Adults ≥60 

years-old against 

Respiratory Syncytial Virus

A SUMMARY REPORT COMPARING MODELS FROM:

GSK, Pfizer AND University of Michigan-CDC

Ismael R. Ortega-Sanchez, PhD

NCIRD/CDC

ACIP Meeting, February 23, 2023

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Disclaimer: 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. 

National Center for Immunization & Respiratory Diseases
Conflict of interest

• GSK model: Daniel Molnar et al., [complete list and affiliations, upon request]

• GSK manufactures the adjuvanted RSVPreF3 vaccine 

• RTI Health Solutions was funded by GSK

• Pfizer model: Derek Weycker et al., [complete list and affiliations, upon request]

• Pfizer manufacturers the bivalent RSVpreF vaccine

• Policy Analysis Inc. was funded by Pfizer

• UM-CDC model: David W Hutton et al. from Univ Michigan, ..., Ismael R Ortega- Sanchez et al. from CDC [complete author list and affiliations, upon request ]

• All authors: No conflicts of interest

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Economic analysis

Policy questions: Should adults ≥60 years of age (or ≥65 years of age) receive one dose of Respiratory Syncytial Virus (RSV) vaccine (GSK or Pfizer product) for 

the prevention of RSV disease and its complications?

Question: Is vaccinating adults aged ≥65 years (or ≥60 years) against RSV cost- effective?

Comparator

Unvaccinated 

≥65yr-olds

(or ≥60yr-olds)

Intervention

Vaccinating

≥65yr-olds

(or ≥60yr-olds)

Base-case scenario: What is the incremental cost-effectiveness of vaccinating adults aged ≥65 years (or ≥60 years) using RSV vaccine relative to “No vaccination”?

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Focus on key features for model comparison

• Modeling approach

• Targeted population(s)

• Perspective (healthcare vs. societal)

• Intervention strategy and comparator

• Inputs for RSV disease burden, vaccine efficacy, and costs

• Incidence of RSV disease, rates of outcomes 

• Direct and Indirect costs of RSV disease

• Intervention: Vaccine efficacy, duration of protection, safety and program 

costs

• Assumptions

• Strong, influential assumptions

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Modeling design and assumptions

GSK Pfizer UM-CDC

Static analytical decision-making models ✔ ✔ ✔

Sensitivity analyses (and probabilistic simulation) ✔(✔) ✔(✔) ✔

Hypothetical population ≥65yrs-old (and ≥60-yrs-old) ✔(✔) ✔(✔) ✔(✔)

Time Frame: at least 1 yr. after a dose of RSV vaccine ✔ ✔ ✔

Analytic Horizon: Age-specific Life Expectancy ✔ ✔ ✔

Discount rate: 3% ✔ ✔ ✔

Year of economic outcomes measured: 2022 ✔ ✔ ✔

Societal perspective (and healthcare perspective) ✔(✔) ✔(✔) ✔(✔)
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Inputs and main outcomes

Prevention of:

• Outpatient visits for RSV

• RSV hospitalizations

• RSV-associated deaths

QALYs saved

$/QALY saved

Number needed to

vaccinate (NNV) to avert an: 

• Outpatient visit for RSV

• RSV hospitalization

• RSV-associated death

GSK Pfizer UM-CDC

✔ ✔ ✔

✔ ✔ ✔

✔ ✔ ✔

✔ ✔ ✔

✔ ✔ ✔

✔ ✔ ✔

✔ ✔ ✔

✔ ✔ ✔

HCRU = health care resource use
UMich-CDC: Scenario analysis for age group, 

$100 vaccine cost and vaccine candidate

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$230 

$181 

$155 

$104 

$234 

$189 

$166 

$117 

 $-

 $50

 $100

 $150

 $200

 $250

age ≥60 years age ≥65 years age ≥70 years age ≥75 years 

Incremental Cost per QALY saved

Thousands

Age Group Vaccinated

GSK Pfizer
GSK, Pfizer and UM-CDC models comparison: 

Selected outcome ratios for RSV vaccines

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UM-CDC 

model

Vac Price 

$100

GSK 

model

Vac Price 

$148

$ / QALY gained

Vaccinating adults ≥65 yrs. 180,720 68,489

Vaccinating adults ≥60 yrs. 229,895 78,971

$ / hospitalization averted

Vaccinating adults ≥65 yrs. 101,406 57,114

Vaccinating adults ≥60 yrs. 133,992 69,638

GSK vaccine

UM-CDC 

model

Vac Price 

$100

Pfizer

model

Vac Price 

$200

$ / QALY gained

Vaccinating adults ≥65 yrs. 189,407 43,749

Vaccinating adults ≥60 yrs. 233,779 50,197

$ / hospitalization averted

Vaccinating adults ≥65 yrs. 122,886 19,845

Vaccinating adults ≥60 yrs. 161,310 23,271

Pfizer vaccine
UM-CDC model: One-way Sensitivity Analyses

Base case: Age ≥65yrs $180,720/QALY (GSK), $189,407/QALY (Pfizer)

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One Year Time Horizon

* At lower bound of Pfizer vaccine efficacy (VE =6.3%), the ICER rises to >$574 Thousand /QALY

$0 $100 $200 $300 $400

Vaccine Cost

Incidence of RSV hospitalization

Outpatient QALYs Lost

GSK Vaccine Effectiveness LRTD

Incidence of outpatient visits for RSV

Cost per Hospitalization

Mortality, adults hospitalized with RSV

GSK Vaccine Effectiveness ARI

ED Incidence

QALYs lost Injection Site Reaction

GSK: $/QALY saved (in thousands)

Low Assumption High Assumption

$0 $100 $200 $300 $400

Pfizer Vaccine Effectiveness LRTD

Vaccine Cost

Incidence of RSV hospitalization

Outpatient QALYs Lost

Pfizer Vaccine Effectiveness ARI

Incidence of outpatient visits for RSV

Mortality, adults hospitalized with RSV

Cost per Hospitalization

ED Incidence

Probability of Serious Adverse Event

Pfizer: $/QALY (in thousands) 

Low Assumption High Assumption

*
GSK model: One-way Sensitivity Analyses

Base case: Age ≥60 years; $ 78,971 /QALY saved

Average annual incidence of first RSV ARI event

Percentage of RSV LRTD cases resulting in hospitalization

Efficacy against RSV LRTD: Waning rates first vaccination with RSVPreF3 vaccine <24 months

Probability of death given RSV LRTD

Proportion RSV LRTD within first RSV ARI event

Vaccination costs per administered dose with RSVPreF3 vaccine - Purchase cost per dose – Cost

RSVPreF3 vaccine: Peak % efficacy after first vaccination against RSV LRTD caused by first RSV 

infection

Baseline QALYs - General population

Efficacy against RSV ARI: Waning rates first vaccination with RSVPreF3 vaccine <24 months

Probability of AE 'Grade 3 ' after first or revaccination with RSVPreF3 vaccine

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Pfizer model: One-way Sensitivity Analyses

Base case: Age≥60 years: $50,104/QALY saved

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Base case
GSK, Pfizer and UM-CDC models comparison: 

Selected inputs 

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• RSV-hospitalization rate

GSK: Proportion of MA RSV hospitalized cases identified by PCR, differentiated by age (Belongia, 2018)

Pfizer: Differentiated by age and comorbidity profile (Pfizer data on file)

CDC: Differentiated by age (four RSV seasons in CDC RSV-NET data)

• Unitary medical cost of RSV outcomes

• GSK: Age- & outcome specific cost for symptomatic RSV LRTD & URTI cases (MA and non-MA) (CMS)

• Pfizer: Age-, outcome- & comorbidity-specific cost for MA RSV

• CDC: Age- & outcome-specific cost for MA RSV

• Initial VE & waning over time

GSK: Phase 3, monthly waning: ARI (5.36%), LRTD (2.63%) until 12mos, then to 0%

Pfizer: Phase 3, flat 7mos, then linear decay to 0% at 24mos

CDC: GSK’s & Pfizer’s phase 3, flat 6mos, exponential decay until 12mos, then to 0%

MA = medically attended, ARI = acute respiratory infection 
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UM-CDC GSK Pfizer

Incidence of RSV outpatient 

illness (per 100,000 persons per 

year)

1,519 

(base-case for adults ≥65 years)a

1,348 

(for adults ≥65 years)b

2,430 

(base case for adults 

≥65 years)c

Incidence of RSV hospitalization 

(per 100,000 persons per year)

108 

(base-case for adults ≥65 years)d

256

(for adults ≥65 years)b,e

300

(base-case for adults 

≥65 years)c

Direct medical costs per RSV 

hospitalization $20,330 – $21,339

(age-dependent)f

$13,112 – $26,224

(age-dependent)g,h

$12,048 – $38,380 

(age- and comorbiditydependent)h,i

a McLaughlin et al. Open Forum Infect Dis (2022): https://doi.org/10.1093/ofid/ofac300; unadjusted for under-detection of RT-PCR testing

b Adapted from Belongia et al. Open Forum Infect Dis (2018): https://doi.org/10.1093/ofid/ofy316

c McLaughlin et al. Open Forum Infect Dis (2022): https://doi.org/10.1093/ofid/ofac300; Ramirez et al. (under review)

d RSV-NET, CDC unpublished data

e Adapted from Falsey et al. NEJM (2005): https://doi.org/10.1056/nejmoa043951; Herring et al. Vaccine (2022): https://doi.org/10.1016/j.vaccine.2021.12.002

f Ackerson et al. J Infect Dis (2020): https://doi.org/10.1093/infdis/jiaa183

g CMS Medicare Inpatient Hospitals (DRG Average Payments from 2019 dataset)

h Kaiser Family Foundation (How much more than Medicare do private insurers pay? 2020): https://www.kff.org/medicare/issue-brief/how-much-more-than-medicare-do-private-insurers-pay-areview-of-the-literature/

i Merative MarketScan Commercial Claims and Encounters (CCAE) and Medicare Supplemental Coordination of Benefits (MDCR) Databases (2016-2019)

GSK, Pfizer and UM-CDC models: Key differences in 

model inputs 
GSK model: Sensitivity of Cost per QALY saved to RSVRelated Hospitalization Rates among Adults ≥60 years

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S8: Branche et al. (2022b; high BoD

season [New York City, 2018-2019]); 

S9: Branche et al. (2022b; low BoD

season [Rochester, 2019-2020]); 

S10: Zheng et al. (2022; low SES); 

S11: Zheng et al. (2022; medium SES); 

S12: Zheng et al. (2022; high SES); 

S13: McLaughlin et al. (2022; 

unadjusted); 

S14: McLaughlin et al. (2022; adjusted); 

S15: Widmer et al. (2012); 

S16: Herring et al. (2022; Belongia et al. 

[2018] estimate); 

S17: Herring et al. (2022; Falsey et al. 

[2005] estimate); 

S18: DeMartino et al. (2022); 

S19: Fust et al. (2022a and 2022b).

Note: BoD = burden of disease; SES = socioeconomic status.

* Derived from GSK modeling results.
S3:

S6:

S1:

S7:

S5:

S4:

S2:

Base-case

Pfizer model: Sensitivity of Cost per QALY saved to RSVRelated Hospitalization Rates among Adults ≥60 years

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• S1: Pooled unadjusted rates from 

McLaughlin et al. (active prospective 

surveillance studies only)1

• S2: Based on pooled adjusted rates from 

McLaughlin et al. 1.5-fold (active 

prospective surveillance studies only)1

• S3: Rates in Rochester, NY, averaged 

across all study years, from Branche et al.2

• S4: Rates in New York, NY, averaged 

across all study years, from Branche et al.2

• S5: Rates averaged across all study years 

and accounting for the proportion of RSVconfirmed cases treated in hospital from 

Belongia et al.3

• S6: Rates based on Matias et al.4

• S7: Rates based on Widmer et al.5

Base Case: Ongoing unvetted prospective 

study with adjusted RSV detection rates of 

1.6- to 1.7-fold. Pfizer Inc. data on file

1. McLaughlin JM, et al. Open Forum Infectious Diseases. 9(7), 2022

2. Branche AR et al. Clinical Infectious Diseases. 2021;74(6):1004-1011. 

3. Belongia et al. Open Forum Infect Dis. 2018;5(12):ofy316.

4. Matias et al. BMC Public Health. 2017;17(1):271.

5. Widmer et al. Influenza and Other Respiratory Viruses. 2014;8(3):347-352.
UM-CDC model: Sensitivity of Cost per QALY saved to RSVRelated Hospitalization Rates among Adults ≥65 years

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Base case: mean value of the burden adjusted rate over RSV seasons: 2015-16, 2016-17, 2017-18, and 2018-19. Adjusted rate for 95% sensitivity of PCR testing. CDC RSVnet

Lower bound: mean of lower confidence limit estimates across all 4 seasons assuming 95% sensitivity of PCR testing. 

Upper bound: mean of upper confidence limit estimates across all 4 seasons assuming 71% sensitivity of PCR testing.

$180,720 

$189,407 

 $-

 $50,000

 $100,000

 $150,000

 $200,000

 $250,000

 $300,000

0 50 100 150 200 250 300 350

Incremental Cost per QALY saved

Incidence of RSV Hospitalization per 100,000 persons per year

GSK

Pfizer

Incidence Range

Minimum

Base Case

Higher Incidence

Scenario
GSK, Pfizer and UM-CDC: Initial or Early Peak 

of Vaccine Efficacy

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a VE over mean 6–7 months of follow up in phase 3 clinical trials

b Manufacturer phase 3 trial data; VE against medically attended acute respiratory illness

c GSK phase 3 trial data; IDWeek abstract; VE against acute respiratory illness, regardless of whether medically attended

d Manufacturer phase 3 trial data; GSK: VE against medically attended lower respiratory tract disease; Pfizer: VE against medically attended lower respiratory tract illness with ≥3 lower 

respiratory symptoms

e Manufacturer phase 3 trial data; GSK: IDWeek abstract VE against lower respiratory tract disease, regardless of whether medically attended; Pfizer: IDWeek abstract VE against lower 

respiratory tract illness with ≥3 lower respiratory symptoms, regardless of whether medically attended (95% CI applied)

UM-CDC GSK Pfizer

GSK vaccine Pfizer vaccine

Vaccine efficacy (VE) against RSV 

outpatient illnessa

79.0 

(54.3–91.5)b

69.2 

(30.0–88.0)b

71.7 

(56.7–82.3)c

69.2 

(30.0–88.0)b

VE against RSV hospitalization and 

emergency department visita

87.5 

(58.4–96.2)d

80.0 

(6.3–97.9)d

82.6 

(57.9–94.1)e

85.7

(37.9–98.4)e
GSK, Pfizer and UM-CDC: Assumption on 

waning of vaccine efficacy (VE) per outcome 

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GSK

VE peaks at 2 months then wanes per month 

RSV-ARI = 5.36% points per month (range: 0.00-

13.37%) 

RSV-LRTD = 2.63% points per month (range: 0.00-

10.95%)

No residual protection after 12 months

Pfizer

Initial VE assumed to persist for 7 months, 

Then to decline linearly to 0% effectiveness at 24 

months

Residual though declining protection up to 24 

months

UM-CDCVaccine and outcome-specific

For both vaccines:

Exponential decay up to 12 months 

and then 0% afterwards; calibrated such that the 

first 6 months VE equals the trial estimate
Pfizer: Impact of vaccine’s duration of protection 

(DoP) assumption on ≥65yrs Cost per QALY saved

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Base-Case

Base-Case

*

* RSV hospitalization incidence labelled “CDC x1.4” used data presented by CDC at IDWeek 2022 (Havers et al. https://doi.org/10.1093/ofid/ofac492.1828), 

upwardly adjusted by a factor of 1.4 (based on Zhang et al. https://doi.org/10.1128/jcm.01701-16).
Comparison of GSK and Pfizer vaccines: base case & 

scenario $/QALY results using UM-CDC model 

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a Recommendation = vaccination at age ≥65 years; vaccine unit cost = $100; incidence rates of RSV outcomes unadjusted for increased diagnostic yield from testing 

in addition to RT-PCR on a respiratory specimen; vaccine efficacy only considered for one year post-vaccination

b Base case incidence rates adjusted upward for increased diagnostic yield from testing in addition to RT-PCR on a respiratory specimen (1.5x for outpatient illness 

[McLaughlin et al; Open Forum Infect Dis (2022)], 1.4x for inpatient illness [Zhang et al; J Clin Microbiol(2016)])

Scenario GSK Pfizer

Vaccine cost $200 per dose (one year time frame) $374,530 $384,267

Vaccinating adults aged ≥60 years $229,895 $233,779

Medical cost for hospitalization (lower bound) $199,018 $205,236

Base case a (Vaccine Price $100, 1 year time frame) $180,720 $189,407

Higherincidence of RSV b $91,028 $104,160

Vaccine cost $50 per dose (one year time frame) $85,815 $91,977
Limitations

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• Factors not considered that may result in overestimating the ICER 

(underestimating the cost-effectiveness) of RSV vaccination

• None of the 3 models included RSV-related medical costs incurred after 

discharge from an RSV-associated hospitalization or emergency department 

visit: 

• Stay in long-term care or rehabilitation facility

• Assisted living at home

• Productivity losses incurred by caregivers whose support is needed post-discharge

• All of the 3 models assumed no indirect effects of vaccination (i.e., no 

protection against RSV transmission)

• Vaccine efficacy beyond clinical trial follow-up time (6–7 months) is unknown

• All 3 models assumed non-zero declining efficacy beyond 6–7 months 

(UM-CDC: 12 months, GSK: 12 months, Pfizer: 24 months).
Conclusion

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• Differences in key inputs among GSK, Pfizer and UM-CDC models explain differences in results:

• Incidence of hospitalization 

• Duration of vaccine efficacy

• Medical costs

• Vaccine costs

• Assumptions and selection of input data were crucial in differences in ICERs

• Adjustment approach of incidence rates of Hospitalization, ER and Outpatient

• Selection of medical costs sources and data extraction approach

• Base-case in the 3 models:

• Vaccination would significantly reduce RSV disease burden in older adults 

• VE clinical trials data and assumptions support impact on disease reduction

• Economic value of RSV vaccines appear to be costly and could be cost-effective 

• RSV incidence, related healthcare costs, initial VE and duration combined with reasonable 

vaccine price would determine the cost-effectiveness value of RSV vaccination
Acknowledgements 

From NCIRD/CDC

• Michael Melgar

• Jamison Pike

• Fiona Havers

• Meredith McMorrow

Also:

• Adult RSV working group members

• Econ Team members at ISD/NCIRD

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End of Summary