Background: Respiratory syncytial virus (RSV) is associated with substantial morbidity in the United States, especially among infants. Nirsevimab, an investigational long-acting monoclonal antibody, was evaluated as an immunoprophylactic strategy for infants in their first RSV season and for its potential impact on RSV-associated, medically attended lower respiratory tract illness (RSV-MALRTI) and associated costs. Methods: A static decision-analytic model of the US birth cohort during its first RSV season was developed to estimate nirsevimab’s impact on RSV-related health events and costs; model inputs included US-specific costs and epidemiological data. Modelled RSV-related outcomes included primary care and emergency room visits, hospitalizations including intensive care unit admission and mechanical ventilations, and RSV-related mortality. Results: Under current standard of care, RSV caused 529 915 RSV-MALRTIs and 47 281 hospitalizations annually, representing $1.2 billion (2021 US dollars [USD]) in costs. Universal immunization of all infants with nirsevimab is expected to reduce 290 174 RSV-MALRTI, 24 986 hospitalizations, and expenditures of $612 million 2021 USD. Conclusions: An all-infant immunization strategy with nirsevimab could substantially reduce the health and economic burden for US infants during their first RSV season. While this reduction is driven by term infants, all infants, including palivizumab-eligible and preterm infants, would benefit from this strategy.

Introduction Respiratory syncytial virus (RSV) leads to significant morbidity in newborn infants in the United Kingdom (UK). Nirsevimab, a long-acting monoclonal antibody, received approval from the European Medicines Agency and has been licensed by the Medicines and Healthcare products Regulatory Agency for preventing RSV lower respiratory tract disease (LRTD) in neonates and infants during their first RSV season. The objective of this study was to assess the potential impact of nirsevimab on RSV-associated LRTDs, related costs, and loss of quality-adjusted life years (QALYs) in infants experiencing their first RSV season. Methods The impact of administering nirsevimab across all infant populations compared to palivizumab in the high-risk palivizumab-eligible population was assessed via a static decision-analytic model specified for a UK birth cohort experiencing their first RSV season. The RSV-related health events of interest included primary care (PC), accident and emergency (A&E) visits, hospitalizations [including hospitalizations alone and those resulting in intensive care unit (ICU) admissions], recurrent wheezing in infants who were previously hospitalized, and all-cause LRTD hospitalizations. Results Under the current standard of practice (SoP), RSV was estimated to result in 329,425 RSV LRTDs annually, including 24,381 hospitalizations and ICU admissions, representing £117.8 million (2024 GBP) in costs. Comparatively, universal immunization of all infants with nirsevimab could avoid 198,886 RSV LRTDs, including 16,657 hospitalizations and ICU admissions, resulting in savings of £77.2 million in RSV treatment costs. Considering the impact on all-cause LRTD of a universal immunization strategy, nirsevimab could be valued between £243 and £274, assuming willingness-to-pay (WTP) thresholds of £20,000 and £30,000 per QALY saved, respectively. Conclusions This analysis demonstrated that the health and economic burden of RSV would be substantially reduced in all infants experiencing their first RSV season in the UK (including term, preterm, and palivizumab-eligible infants) as a result of a universal immunization strategy with nirsevimab.

We read with interest the study by Kura et al

Background: Recent clinical trials have demonstrated improved efficacy of combination regimens, including amivantamab plus lazertinib and osimertinib plus platinum-based chemotherapy, compared with standard therapy in patients with epidermal growth factor receptor (EGFR)–mutated non-small cell lung cancer (NSCLC). As these regimens enter routine clinical use, understanding the economic implications of treatment-related adverse event (AE) management, including proactive therapy management (PTM), is important. Objectives: To estimate and compare grade 3 or 4 AE management costs associated with first-line amivantamab (intravenous [IV] or subcutaneous [SC]) plus lazertinib and osimertinib plus platinum-based chemotherapy in patients with EGFR-mutated locally advanced or metastatic NSCLC from a US Commercial and Medicare Advantage payer perspective. Methods: A descriptive cost modeling analysis used grade 3/4 AE incidence data from pivotal clinical trials of amivantamab (IV and SC) plus lazertinib and osimertinib plus platinum-based chemotherapy. AEs occurring in ≥5% of patients or deemed clinically significant were included. PTM strategies for dermatologic events, venous thromboembolism, and infusion-related reactions were modeled for amivantamab-based regimens using guideline-concordant practices and clinical trial evidence. As a conservative assumption, PTM for osimertinib plus platinum-based chemotherapy was not included. AE management costs were derived from national inpatient and physician fee schedules and inflated to 2025 US dollars. Total per-patient AE management and PTM costs were estimated for each treatment regimen. Scenario analyses evaluated expanded PTM assumptions. Results: Across both payer perspectives, total AE management costs were estimated to be lower for amivantamab-based regimens than for osimertinib plus platinum-based chemotherapy. Under the Commercial perspective, modeled AE management costs were $2345 for amivantamab (SC) plus lazertinib, $4321 for amivantamab (IV) plus lazertinib, and $8497 for osimertinib plus platinum-based chemotherapy. Corresponding Medicare Advantage estimates were $1166, $2425, and $4185, respectively. Inclusion of PTM costs did not alter the relative cost ranking calculated and findings were consistent across scenario analyses. Conclusions: Results from this descriptive cross-trial analysis indicated that total AE management costs were consistently estimated to be lower in patients receiving amivantamab (SC or IV) plus lazertinib compared with osimertinib plus platinum-based chemotherapy across both a Commercial and Medicare Advantage payer perspective.