Modelling the cost-effectiveness of RSV interventions in England and Wales.

RSV causes acute lower respiratory tract infections (ALRI) in people of all ages, but especially in children under 5 years and the elderly. New monoclonal antibodies, offering rapid immune protection to infants, maternal vaccines, conferring protection to infants through placental transfer of antibodies, and elderly vaccines are becoming available. Recently, a maternal vaccine (Abrysvo) and a monoclonal antibody (Nirsevimab) have demonstrated higher efficacy and duration of protection than the current prophlaxis, Palivizumab in phase 3 trials and were approved for use against RSV in infants by the U.S. FDA and European Medicines Agency in September 2023.

In this project, I used mathematical modelling to assess the impact and cost-effectiveness of these new interventions taking into account waning immunity and herd immunity using a whole-population-wide age-startified compartmental model of in England and Wales. This work is an extension of previous study by Hodgson et al. 2020 and for fullfilment of my Master of Epidemiology at the University of Antwerp. Supervision by Professor Lander Willem at the Centre for Health Economics and Modelling of Infectious Diseases (CHERMID) at the University of Antwerp, Belgium.

Structure of RSV model used for this study.

Implementation guide

Quick instructions

Clone the repository and look through the RMarkdown file in the /vingettes folder for implementation steps.

Overview of files

/data folder

• posteriors.Rda, is dataframe which contains posterior distributions from Hodgson et al 2020.
• states.csv, is a dataframe which contains the generated initial states used in this study. The procedure is described in the /vignettes folder.
• uk_data_sum.RData, is a dataframe which contains information on the population of England and Wales used for generating the initial states.

/figs folder

• contains main and supplementary plots and tables.

/parameter_sources folder

• contains source publications for costs, model and intervention parameters.

/functions folder

• RunInterventions.R, contains all the funtions used for the analysis, generating tables and figures.
• rsv_model_merged.R, is the age-stratified RSV model used in the analysis.

/main folder

• aging_check.R, a walkthrough to assess the implementation of the aging process in the model.
• check_health_vac.R, a walkthrough to assess the implementation of the epidemiological and vaccination process of the model.
• figure_3.R, plotting function for figure 3 in the main outputs.
• generate_initial_states.R, a walkthrough of generating the initial states.
• annual_incidence.R, plotting function for figure 1 in the main outputs.
• scenarios_cost_effect.R, a walkthrough of estimating the impact of the intervention strategies and their cost-effectiveness.
• tables.R, a walkthrough of generating all tables in the study.

/vingettes folder

• scenarios_run.Rmd, markdown file with instructions to reproduce analysis, figures and tables.

Contact details

Please email [email protected] with any queries relating to this code.