Today, the Health Information and Quality Authority (HIQA) published its rapid health technology assessment (HTA) of immunisation against respiratory syncytial virus (RSV) in Ireland. This rapid HTA has been submitted as advice to the Minister for Health and the Health Service Executive (HSE) to inform an interim policy decision on the most appropriate RSV immunisation strategy for the 2025-2026 RSV season. In particular, HIQA’s assessment looked at the one-year costs for the HSE of different immunisation strategies involving infants aged less than one year and for adults aged 65 and older.

RSV is a highly contagious virus that infects the lungs and upper airways and is transmitted by coughing, sneezing or breathing. This virus spreads every winter, with the RSV season in Ireland typically running from October to March. 

In most people, infection with RSV can be managed without needing to see a doctor. However, RSV can cause more severe infections that can lead to hospitalisation. Groups vulnerable to serious complications include infants, young children and older adults. A large number of children, and in particular infants aged less than one year, are hospitalised due to RSV each year. The majority of these hospitalisations occur in the last three months of the year, posing a particular challenge for paediatric healthcare services.

Dr Máirín Ryan, HIQA’s Deputy CEO and Director of Health Technology Assessment, said: “Since 2022, new medicinal products have become available to protect infants and older adults against RSV, with clinical trial data and emerging real-world evidence supporting the safety and effectiveness of these products.”

HIQA undertook a costing analysis for a range of potential immunisation strategies. The estimated one-year cost to the HSE of immunising infants during their first RSV season ranged from €3.9 million to €19 million, depending on the approach taken. These costs would be partially offset by the fact that fewer infants would require hospital care.

Offering an RSV vaccine to everyone aged 65 years and older was estimated to cost €146 million, while it would cost over €76 million if only offered to those aged 75 years and older. The potential for cost offsets in older adults was noted to be low as there are relatively few confirmed hospitalisations for RSV in this age group. The analysis highlighted substantial uncertainty in relation to these one-year costs.

Dr Ryan continued: “There would be substantial organisational challenges associated with extending RSV immunisation to the general infant and or older adult population, given the large number of individuals involved and the aim to maximise uptake within a short time frame before the start of the RSV season. Furthermore, given the uncertainty in relation to the cost associated with the different RSV strategies, we advised that the product cost should be a key consideration in any decision-making. 

“Data collection will be important to support the ongoing monitoring and evaluation of the effectiveness of any programme that is implemented. A public campaign would also be essential to raise awareness and support informed decision-making.”

HIQA will now conduct a larger assessment to provide advice to inform a longer-term policy decision about RSV immunisation. This will include emerging international evidence as well as experience from the HSE’s RSV Immunisation Pathfinder Programme, which is being piloted for the upcoming 2024-2025 season.

ENDS

Further information: 
Marty Whelan 
Head of Communications and Stakeholder Engagement 
085 805 5202 
mwhelan@hiqa.ie

Notes to the Editor: 
• HIQA undertook this rapid HTA at the request of the Department of Health. This followed a clinical recommendation from the National Immunisation Advisory Committee (NIAC) regarding the immunisation of infants and older adults against RSV. Information in relation to NIAC is available here.
• Information in relation to RSV is available from the HSE here.
• Strategies for prevention of RSV in the general population typically focus on encouraging behaviours which may reduce virus transmission, such as reducing social contacts when an individual is symptomatic, and encouraging good hand hygiene and respiratory hygiene practices. 
• Recently, two forms of immunisation for infants have been authorised in Europe. The first, nirsevimab (Beyfortus®), is administered directly to the infant, and the second, RSVpreF (Abrysvo®), is administered to pregnant women, thereby providing infant protection through transplacental antibody transfer. Two vaccines have also been authorised for the immunisation of adults aged 60 years and older: RSVpreF (Abrysvo®) and RSVPreF3 (Arexvy®).
• Protection against RSV is not currently offered to healthy infants and adults in Ireland. However, palivizumab (Synagis®) is provided by the HSE for a small number of infants and young children who are considered at high risk of severe disease caused by RSV. HIQA’s assessment found that switching from palivizumab to nirsevimab for these infants and children would cost less than current care.
• On 18 June 2024, the Minister for Health announced the RSV Immunisation Pathfinder Programme, which is being piloted as a temporary measure for the upcoming 2024-2025 season. Through this programme, parents of babies (limited to those born from September 2024 to February 2025) will be encouraged to have their babies immunised free of charge before leaving the maternity unit. Information in relation to the Pathfinder Programme is available here.