Vaccination Amid Limited RSV Therapy Options for Adults

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Medical experts discuss the lack of RSV treatment leading to the importance of immunization.

Ryan Haumschild, PharmD, MS, MBA: When we think about treatment, obviously vaccine is one of the best ways to be proactive, but not every patient is going to be there. One of the things you want them to understand is there aren’t many great treatments for RSV [respiratory syncytial virus] if you’re not proactive and being more preventative in your strategies. Dr Bridgeman, with the lack of definitive treatments for RSV in adults, what are some of the possibly effective treatments that were being currently utilized for RSV?

Mary Bridgeman, PharmD, BCPS, BCGP, FASCP: So aerosolized ribavirin therapy has been utilized, but just by saying that out loud, I think we all realize that this is a cumbersome therapy to have to administer to patients. It is expensive. It’s associated with fairly significant toxicities. Other therapies that have been utilized include steroids, corticosteroids maybe. Intravenous immunoglobulins have been trialed as well. In infants at high risk for RSV, there is the monoclonal antibody palivizumab [Synagis] that’s associated with or has been utilized. It’s a humanized RSV- specific monoclonal antibody indicated for RSV prevention in that particular population. But again, for adults, [there are] not a whole lot of fantastic options available.

Ryan Haumschild, PharmD, MS, MBA: That’s a little worrisome, especially as a payer and a provider, because a lot of times those are high-cost nonspecific medications. I mean, what don’t we use steroids for sometimes when we’re treating patients? So the more proactive we can be [the better]. I know for me, that’s one thing I’d love to not have to go down that route of treatment and actually just prevent RSV altogether. Dr Madison, we talked about different patient populations, which patient population would benefit most from the RSV vaccine? I think maybe all of us, but I’d like you to answer that question and drill down even further are there any patient populations that would not benefit from an RSV vaccine?

Christina Madison, PharmD, FCCP, AAHIVP: At this point, if you’re otherwise healthy or well and don’t have one of those complications that we talked about, if you’re not a current smoker, have asthma, COPD [chronic obstructive pulmonary disease] or cardiovascular disease, specifically heart failure, and you’re not on any kind of medication that could suppress your immune system, there probably isn’t a ton of benefit that you would get from vaccination. And then obviously as we await the anticipated approval of this new product specifically in pregnant folks, I think just looking at it from the standpoint of who’s really at risk. We know that if you look at the ACIP [Advisory Committee on Immunization Practices] recommendations for vaccinations and utilizing the CDC [Centers for Disease Control and Prevention] vaccination schedule, there are 2 different ways you can look at it.

You can do it age-based, which is 1 table of that particular schedule. And then there’s one really just looking at medical conditions and higher risk cases that you would be indicated to receive that vaccine. I have a feeling that ACIP is probably going to do a little bit of both, where you’re going to see specific patient populations, like COPD, asthma, underlying lung conditions, and those who are chronically immunosuppressed. They’ll probably have 2 different buckets, 1 specifically for those who are HIV-positive, and then those who are immunosuppressed not due to HIV. And then you’ll have that heart failure/cardiovascular risk as well. You’ll see those individuals regardless of age and then specifically an age-based recommendation as well.

Ryan Haumschild, PharmD, MS, MBA: I like the breakout between those 2. And I definitely look to the ACIP a lot for recommendations.

Christina Madison, PharmD, FCCP, AAHIVP: And there’s an app for that.

Ryan Haumschild, PharmD, MS, MBA: And there’s an app for that. Excellent.

Christina Madison, PharmD, FCCP, AAHIVP: I love my technology. I’m all about [working] smarter, not harder.

Ryan Haumschild, PharmD, MS, MBA: Anything we can do to leverage ourselves and our pharmacy team members to stay up to date on the best vaccination schedules is always a great thing. Thanks for highlighting that. Dr Welch, we have the 2030 healthy goals. If you could, please explain to us the financial and clinical goals associated with immunizing against RSV, specifically in adults.

Adam C. Welch, PharmD, MBA, FAPhA: There’s a goal within healthy people in 2030 that I think is fantastic. It’s broad enough that it can be applied to a lot of different vaccine-preventable diseases. They’re basically looking at adults 19 and older receiving the age-recommended vaccines that they’re supposed to, according to what ACIP and the CDC come out with. So as RSV vaccines go through the approval process and are recommended by the CDC that would fall into this global health goal of let’s improve where we’re at now. Now the baseline for this is going to be [determined] we haven't given RSV vaccines before, but having an increase in that is certainly a goal for it.

Now, when you look at the financial implications of this, the CDC and the drug companies who manufacture these vaccines have actually done some analyses. They do it in a way where they say, how much does it costs for this vaccine to gain a quality-adjusted life year, so a QALY. The price then becomes important when you’re looking at the public health impact of this. I’ll give you some numbers here. For the vaccine currently available, the range was $68,000 per quality-adjusted life year gained up to $180,000, depending on if you’re using a drug manufacturer’s model or the CDC’s model. And they vary in the inputs that you put in. The cost of the vaccine factors into it, the number of hospitalizations, how much hospitalizations cost, and the efficacy of the vaccine. We’re looking at basically 1 RSV season’s worth of efficacy.

So $68,000 to $180,000 is the range to gain a quality-adjusted life year. Is that good? Well, you can try to compare it to other respiratories, but it’s not a good comparison. Flu is typically less expensive, but it really depends greatly on how well the influenza vaccine matches what is circulating throughout the country. It’s hard to make that comparison. In some years, influenza is cost savings. The other vaccine that was just being discussed in maternal had a range of $43,000 up to $189,000. And it also depends on if you’re preventing the severe disease or preventing disease based on symptoms that are less severe. So there is an economic cost to RSV, but that is valuable in the grand scale of how we’re using vaccines as far as preventing public health and those complications that we discussed in the hospitals ICU [intensive care unit] stays and missed work and all of these other complications that may exist.

Ryan Haumschild, PharmD, MS, MBA: I'm a self-professing pharmacoeconomic nerd and I would say one of the things when we look at these incremental cost-effective ratios and we look at these QALYs, it really makes a strong argument for vaccines that if you can be proactive, you really are going to provide not just a public health benefit, but also a financial benefit to the payer, the plan, the employer, and obviously help reduce some of that health care resource burden on our providers.

Transcript edited for clarity.

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