{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:08:36Z","timestamp":1792026516240,"version":"4.4.0"},"reference-count":54,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections and hospitalizations among infants in Canada. New long-acting monoclonal antibodies (mAbs) and vaccines administered during pregnancy have expanded prevention options, yet the most cost-effective immunization program remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We updated a Canadian cost-utility model to evaluate seven seasonal RSV prevention strategies over one year (with a lifetime horizon for mortality impacts), from health system and societal perspectives. Strategies included RSVpreF vaccination in late pregnancy; targeted or universal infant mAb programs using nirsevimab or clesrovimab; and combination programs in which infants could receive protection from either RSVpreF or mAbs. Sequential incremental cost-effectiveness ratios (ICERs) were estimated in 2024 Canadian dollars per quality-adjusted life year (QALY), using a $50,000\/QALY threshold. The primary analysis used immunization product list prices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      The most cost-effective strategy was a seasonal combination program: RSVpreF vaccination for pregnancies due during the RSV season, with mAb for infants at high risk (&lt;32 weeks\u2019 gestation), including catch-up for infants at high risk born before the season. This strategy had an ICER of $35,408\/QALY compared to seasonal mAb for infants at moderate risk (32\n                      <jats:sup>0\/7<\/jats:sup>\n                      to 36\n                      <jats:sup>6\/7<\/jats:sup>\n                      weeks\u2019 gestation) or high-risk with catch-up. Expanding mAb to unimmunized non-high-risk infants born in-season increased the ICER to $132,131\/QALY. Universal infant protection, with mAb alone or combined with RSVpreF in pregnancy, was not cost-effective across analyses. RSVpreF alone was dominated. Results were most sensitive to product prices, target populations, age at administration, and RSV burden.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A seasonal combination program with RSVpreF for in-season deliveries and mAb for infants at high risk of RSV offers the best value for money for protecting Canadian infants from RSV disease. Broader infant immunization programs may be cost-effective with substantial price reductions or in regions with higher disease burden and healthcare costs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0351183","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T17:43:46Z","timestamp":1781286226000},"page":"e0351183","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Evaluating respiratory syncytial virus immunization strategies for infants in Canada: A cost-utility analysis"],"prefix":"10.1371","volume":"21","author":[{"given":"Gebremedhin B.","family":"Gebretekle","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8421-8765","authenticated-orcid":true,"given":"Marie","family":"Lan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Xi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael","family":"Ximenes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah A.","family":"Buchan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elissa M.","family":"Abrams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa K.","family":"Andrew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Brousseau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"April","family":"Killikelly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Money","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4232-871X","authenticated-orcid":true,"given":"Jesse","family":"Papenburg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Rafferty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan L.","family":"Robinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5772-1509","authenticated-orcid":true,"given":"Winnie","family":"Siu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Tunis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4373-9337","authenticated-orcid":true,"given":"Ashleigh R.","family":"Tuite","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"issue":"7","key":"pone.0351183.ref001","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1093\/jpids\/piad045","article-title":"Estimating the incidence of first RSV Hospitalization in Children Born in Ontario, Canada","volume":"12","author":"SA Buchan","year":"2023","journal-title":"J Pediatric Infect Dis Soc"},{"issue":"10","key":"pone.0351183.ref002","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.36863","article-title":"Canadian Immunization Monitoring Program Active (IMPACT) Investigators. Pediatric RSV-Associated Hospitalizations Before and During the COVID-19 Pandemic","volume":"6","author":"M Bourdeau","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"3","key":"pone.0351183.ref003","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0150416","article-title":"Incidence of hospitalization for respiratory syncytial virus infection amongst children in Ontario, Canada: a population-based study using validated health administrative data","volume":"11","author":"A Pisesky","year":"2016","journal-title":"PLoS One"},{"key":"pone.0351183.ref004","doi-asserted-by":"crossref","first-page":"1","DOI":"10.14745\/ccdr.v50i12a01","article-title":"Burden of disease of respiratory syncytial virus in infants, young children and pregnant women and people","volume":"50","author":"EM Abrams","year":"2024","journal-title":"Can Commun Dis Rep"},{"issue":"4","key":"pone.0351183.ref005","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1097\/INF.0000000000002164","article-title":"Characteristics and outcomes of young children hospitalized with laboratory-confirmed influenza or respiratory syncytial virus in Ontario, Canada, 2009-2014","volume":"38","author":"SA Buchan","year":"2019","journal-title":"Pediatr Infect Dis J"},{"key":"pone.0351183.ref006","first-page":"100582","article-title":"Respiratory syncytial virus epidemiology and clinical severity before and during the COVID-19 pandemic in British Columbia, Canada: a retrospective observational study","volume":"25","author":"M Vi\u00f1eta Paramo","year":"2023","journal-title":"Lancet Reg Health Am"},{"issue":"9","key":"pone.0351183.ref007","doi-asserted-by":"crossref","first-page":"381","DOI":"10.14745\/ccdr.v47i09a05","article-title":"Burden of illness in infants and young children hospitalized for respiratory syncytial virus: A rapid review","volume":"47","author":"A Wingert","year":"2021","journal-title":"Can Commun Dis Rep"},{"key":"pone.0351183.ref008","first-page":"4521302","article-title":"Burden of Respiratory Syncytial Virus Hospitalizations in Canada","volume":"2017","author":"I Mitchell","year":"2017","journal-title":"Can Respir J"},{"key":"pone.0351183.ref009","volume-title":"Statement on the prevention of respiratory syncytial virus (RSV) disease in infants","author":"National Advisory Committee on Immunization","year":"2024"},{"issue":"21","key":"pone.0351183.ref010","doi-asserted-by":"crossref","first-page":"126164","DOI":"10.1016\/j.vaccine.2024.126164","article-title":"Cost-effectiveness of RSVpreF vaccine and nirsevimab for the prevention of respiratory syncytial virus disease in Canadian infants","volume":"42","author":"GB Gebretekle","year":"2024","journal-title":"Vaccine"},{"key":"pone.0351183.ref011","unstructured":"DeSilva M. 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Table 18-10-0005-01","author":"Statistics Canada","year":"2023"},{"key":"pone.0351183.ref040","doi-asserted-by":"crossref","DOI":"10.1093\/infdis\/jiac183","article-title":"Impact of respiratory syncytial virus on child, caregiver, and family quality of life in the United States: systematic literature review and analysis","volume":"226","author":"EL Glaser","year":"2022","journal-title":"J Infect Dis"},{"key":"pone.0351183.ref041","author":"LM Roy","year":"2013"},{"issue":"40","key":"pone.0351183.ref042","doi-asserted-by":"crossref","first-page":"4347","DOI":"10.1016\/j.vaccine.2013.07.024","article-title":"Respiratory syncytial virus immunization program for the United States: impact of performance determinants of a theoretical vaccine","volume":"31","author":"SA R\u00e9gnier","year":"2013","journal-title":"Vaccine"},{"key":"pone.0351183.ref043","volume-title":"Palivizumab Prophylaxis in Alaska for the 2022\u201323 RSV Season. 11","author":"R 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Bugden","year":"2025","journal-title":"BMC Med"},{"key":"pone.0351183.ref050","first-page":"100629","article-title":"Cost-effectiveness analysis of nirsevimab and maternal RSVpreF vaccine strategies for prevention of Respiratory Syncytial Virus disease among infants in Canada: a simulation study","volume":"28","author":"A Shoukat","year":"2023","journal-title":"Lancet Reg Health Am"},{"issue":"1","key":"pone.0351183.ref051","doi-asserted-by":"crossref","first-page":"2480875","DOI":"10.1080\/21645515.2025.2480875","article-title":"Health economic evaluation of implementing a universal immunization program with nirsevimab compared to standard of care for the prevention of respiratory syncytial virus disease in Canadian infants","volume":"21","author":"T Shin","year":"2025","journal-title":"Hum Vaccin Immunother"},{"key":"pone.0351183.ref052","volume-title":"Cost-effectiveness of nirsevimab for the prevention of respiratory syncytial virus outcomes in infants","author":"R 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