Abstract
BACKGROUND: Respiratory syncytial virus (RSV) causes significant morbidity and mortality worldwide, particularly in high-risk groups. Despite the availability of preventive interventions, it is crucial to evaluate the economic benefits of these interventions. METHODS: This systematic review assessed the cost-effectiveness and model structures of RSV prevention strategies, including vaccines and monoclonal antibodies, by analyzing studies published up to March 2025. RESULTS: A total of 39 studies were included, comprising one cost-benefit analysis (CBA) and 38 cost-effectiveness analyses (CEAs), utilizing six different types of economic models. The incremental cost-effectiveness ratio (ICER) among the older adult population varied from $5,342 to $385,829 per quality-adjusted life year (QALY). One study demonstrated superior cost-effectiveness of a long-acting monoclonal antibody (LAMA) compared to a short-acting monoclonal antibody, with both being more economically favorable than maternal vaccines for pregnant women and neonates. The most sensitive variables were intervention efficacy, price, and immunity duration. CONCLUSION: Most RSV vaccines and monoclonal antibody interventions demonstrate cost-effectiveness in specific populations and settings. However, cost-effectiveness is highly influenced by intervention price, efficacy, duration, populations, and administration time. SYSTEMATIC REVIEW REGISTRATION: The protocol for this study has been registered with PROSPERO under the registration number CRD42024524720.