Economic Value and Cost-Effectiveness of Respiratory Syncytial Virus Vaccination in Adults: A Systematic Review

Abstract

Background: Respiratory syncytial virus (RSV) is a major cause of acute respiratory infections among older adults and individuals with chronic medical conditions. Recently developed RSV vaccines have demonstrated clinical efficacy, but their economic value remains unclear across different healthcare settings and target populations. Objective: This systematic review aimed to evaluate the cost-effectiveness of RSV vaccination strategies in adults and older adults and to identify key factors influencing economic outcomes. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. PubMed, ScienceDirect, and Scopus were searched from inception to 9 January 2026. Eligible studies included full economic evaluations assessing RSV vaccination compared with no vaccination or standard care. Primary outcomes were willingness-to-pay (WTP) thresholds, quality-adjusted life years (QALYs), and incremental costs. Secondary outcomes included vaccine waning efficacy and number needed to vaccinate (NNV). Methodological quality was assessed using the ECOBIAS checklist. Results: Eleven model-based economic evaluations were included. Most studies employed static multi-cohort Markov models, with study horizons ranging from one to five years. Vaccination generally demonstrated favorable cost-effectiveness profiles among adults aged 60 years and older, particularly in populations with chronic comorbidities such as chronic obstructive pulmonary disease (COPD), cardiovascular disease, diabetes mellitus (DM), obesity, and renal disease. Reported WTP thresholds ranged from 29.72 to 100,000 per QALYs gained. Cost-effectiveness varied substantially according to vaccine price, RSV incidence, hospitalization risk, duration of protection, and analytical perspective. Studies evaluating the NNV reported values ranging from 8 to 28 to prevent one RSV-associated acute respiratory infection case, while waning efficacy analyses demonstrated declining vaccine protection over time. Targeted vaccination strategies for high-risk populations consistently produced more favorable economic outcomes than universal age-based vaccination approaches. Conclusion: RSV vaccination is generally cost-effective, specifically under the risk-based strategies applied in older adults with underlying comorbidities that provide greater economic value than widespread programs, although future research should incorporate aligned transmission models and extended real effectiveness data to address long-term waning immunity and support sustainable policies.