RSV vaccines for babies too expensive at current prices, Hiqa warns 

A pilot vaccine programme running for the last two winters has seen a collapse in RSV numbers among babies. However Hiqa has now advised future costs could range from €15.6m to €58.5m over five years depending on the type of immunisation used. File picture

The RSV vaccines used for babies are too expensive at current prices even though they are “safe and effective”, Hiqa has told the health minister.

Costs need to be almost halved before they would be cost-effective, the regulator will tell Jennifer Carroll MacNeill and the HSE today in its final report.

A pilot vaccine programme running for the last two winters has seen a collapse in RSV numbers among babies. However Hiqa has now advised future costs could range from €15.6m to €58.5m over five years depending on the type of immunisation used.

Up to two years ago, RSV posed a real risk for babies with about 1,800 young children in hospital every year including 130 needing intensive care.

Almost all of those in hospital were aged under 12 months and most cases came between October and December.

The minister asked Hiqa to evaluate this pilot for long-term use.

Deputy chief executive and director of health technology assessment Máirín Ryan said: “RSV immunisation significantly reduces hospitalisation with the greatest benefit in infants due to the highest burden of disease in this patient group.

“While it would reduce winter overcrowding and help make our health service more resilient, it is very expensive.

Our healthcare budget is finite, and cost-effectiveness is an important part of any healthcare decision.

Hiqa’s final advice following a draft report last year also said: “RSV immunisation has the potential to be cost-effective, particularly in infants, if the HSE can secure substantial price reductions.”

The health watchdog said it found “considerable uncertainty” around the cost of RSV treatments globally.

The HSE could likely ensure a reduction with “a competitive tender process” the report said.

It estimated a five-year budget of €15.6m for a campaign based on vaccines for mothers at a cost of €165 each excluding Vat.

Costs for the maternal vaccine would need to be as low as “at least €90” to be cost effective, it estimated.

A budget as high as €58.5m over five years would be needed if babies are immunised with a monoclonal antibody at a cost of €301 per baby.

It said instead this would only be cost-effective at €166 per immunisation.

Older people, especially people over 80, are also at high risk of hospitalisation and dying from RSV.

Hiqa said that the vaccine is also “safe and effective” for this cohort but noted the effectiveness wanes over time.

The estimated cost of vaccinating all over 80s is €70.6m over five years.

Ms Ryan said about 120 people aged over 65 are in hospital every winter with RSV, and about half of those are over 80.

In response the HSE said its data shows a 71% reduction in children admitted to intensive care units.

“Hiqa are correct in highlighting the significant costs associated with this programme and the need to negotiate the best possible price for RSV immunisation products,” a spokesman said.

“The HSE is currently planning for implementation of our third RSV immunisation programme while a final decision on a national programme beyond winter 2026/27 is awaited from the Department of Health.” 

A department spokeswoman confirmed the third year of the pilot programme continues this winter.

The department will work with the HSE and Hiqa “to consider the findings and options set out in the assessment, including operational and budget impacts, ahead of decisions on a longer-term RSV immunisation strategy”, she said.

The report included a submission from Children’s Health Ireland.

It saw a 30% drop in all-cause bronchiolitis visits during the first winter the pilot ran. It also saw a 40% drop in admissions.

Last week the deputy chief medical officer Ellen Crushell said numbers of children in hospital with RSV have “collapsed” since the pilot immunisation programme started.

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