Expanding vaccination against a potentially fatal respiratory virus to infants would result in “significant reductions” in the number of babies hospitalised with the illness, the health and safety watchdog has said.
On Tuesday, the Health and Information and Quality Authority (Hiqa) published a health technology assessment of immunisation against respiratory syncytial virus (RSV) in Ireland for infants and older adults.
RSV is a common seasonal viral infection that affects the lungs and upper airways. Infants and older people are at increased risk of severe illness.
Every winter in Ireland, more than 7,000 people are diagnosed with RSV, with a large number of young children generally requiring admission to hospital, especially infants aged less than one year.
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For the infant population, Hiqa looked at immunising just those born during the RSV season or all babies during their first RSV season. It also considered different immunisation products, including a maternal vaccine for the mother, or a monoclonal antibody, administered to the baby.
All RSV immunisation products considered were found to be safe and effective, the watchdog said, and all of the approaches would result in significant reductions in medically attended cases and RSV-related hospitalisations in infants.
The estimated cost to the HSE over five years ranged from €15.6 million to provide the maternal vaccine to pregnant women whose baby will be born during RSV season, to €58.5 million for a strategy providing a monoclonal antibody to all babies during their first RSV season.
However, the organisation said there was “considerably uncertainty” in relation to these costs.
For the older adult population, RSV vaccination was also found to be safe and effective. However, the effectiveness of the vaccines, which are given as a one-off dose, wanes over time.
The estimated cost of offering the vaccine to adults aged 80 years and older, the adult age group who are most at risk of RSV-related hospitalisation and death, was €70.6 million over five years.
Hiqa said the current list price for the vaccine, €165 excluding VAT, meant none of the modelled strategies for older people would be cost effective.
“A strategy of providing immunisation to those aged 80 years and older in year one of the programme and those aged 80 years only in subsequent years would be cost effective at a vaccine price of €20 or less (ex VAT), that is an 88 per cent reduction relative to currently available list prices,” the report said.
Dr Máirín Ryan, deputy chief executive of Hiqa and director of health technology assessment, said RSV placed a substantial burden on vulnerable groups and on the healthcare systems.
“RSV results in approximately 1,800 hospital discharges and 130 ICU stays in children aged less than two years each year. Approximately nine in every 10 of these discharges are in children aged less than one year and occur mostly between October and December,” she said.
“In those aged 65 years and older, there are approximately 120 discharges each year with a primary diagnosis of RSV. Approximately one in every two of these discharges are in those aged 80 years and older. These seasonal RSV surges can lead to scheduled care being delayed, increase pressure on staff and undermine the resilience of the healthcare system.”
Ryan said immunisation “significantly reduces” hospitalisation, with the greatest benefit in infants.
“While it would reduce winter overcrowding and help make our health service more resilient, it is very expensive. Our healthcare budget is finite, and cost effectiveness is an important part of any healthcare decision,” she added.
For the past two winter seasons, the HSE has run pilot RSV immunisation programmes that dramatically reduced the number of babies hospitalised with the virus.
