Background and Aim
Oral antiviral therapies were shown in clinical trials to reduce the risk of severe COVID-19 outcomes among high-risk populations. In Australia, molnupiravir (Lagevrio) and nirmatrelvir–ritonavir (Paxlovid) became available in early 2022 through the Pharmaceutical Benefits Scheme (PBS). This study aimed to describe sociodemographic and geographic patterns of COVID-19 oral antiviral dispensing in Australia.

Methods and Analysis
We conducted a population-based observational study using linked national administrative data from the Australian Immunisation Register and the Person Level Integrated Data Asset (AIR-PLIDA) for the period July 2022 to December 2024. Dispensing patterns were examined by age, sex, jurisdiction, and area-level socioeconomic status using the Index of Relative Socio-Economic Advantage and Disadvantage. Crude dispensing rates per 1,000 population were estimated and mapped at the Statistical Area Level 2 for adults aged 70 years and older, a universally eligible group.

Outcomes
Between July 2022 and December 2024, 1,639,148 oral COVID-19 antiviral prescriptions were dispensed nationally to 1,472,772 individuals. Molnupiravir accounted for 62.4% of dispensing and nirmatrelvir–ritonavir for 37.5%. Repeated dispensing occurred in 10.3% of people. Dispensing was highest during late 2022, followed by lower but recurrent increases in mid-2023 and early 2024. Dispensing increased with age, peaking at 75–79 years (20.1%, median age=76 years), and was higher among females (58.0%) and residents of socioeconomically advantaged areas (31%). Among adults aged ≥70 years, the average dispensing rate for both antivirals varied markedly by jurisdiction, exceeding 500 per 1,000 population in the Australian Capital Territory and remaining below 200 per 1,000 in other jurisdictions with the lowest coverage in South Australia.

Conclusion and Future Actions
Despite national eligibility criteria, access to oral COVID-19 antivirals in Australia varied by socioeconomic status and geography. These results can inform targeted implementation strategies to improve equity and real-time monitoring systems to strengthen responses to future pandemics.

Background and Aim: The Australian COVID-19 landscape has changed at pace since 2020. However, there remains limited Australian evidence on vaccine effectiveness (including primary series and boosters) against hospitalisation, and changes in effectiveness across years and successive variant-dominant periods. This test-negative case control study aims to estimate protection from a recent dose of a COVID-19 vaccine against hospitalisation from COVID-19 in people aged over 18 years.

Methods and Analysis: FluCAN is a national hospital-based sentinel surveillance system established in 2009 and expanded in 2020 to include patients hospitalised with COVID-19. Data was collected for all hospitalised COVID-19 patients (and randomly-selected test-negative controls) from 1 January 2022 – 31 December 2025 admitted to one of 17 sentinel hospitals across Australia. Vaccine effectiveness was estimated from a conditional logistic regression separately by age group, time since vaccination, year, and predominant circulating strain.

During the study period there were 27,652 reported COVID-19-related hospitalisations and 4,259 controls from FluCAN sentinel sites. Vaccine effectiveness against hospitalisation was highest in adults aged ≥75 years with existing risk factors (12-month effectiveness: 25%, 95%CI: 16%, 33%; 6-month effectiveness: 32%, 95%CI: 24%, 38%). Effectiveness is highest in the 60 days post-vaccination for all age groups and steadily decreases thereafter. There was insufficient evidence to conclude that protection varied by year or by different ‘waves’ of predominant circulating strains.

Outcomes: This large Australian study identified that COVID-19 vaccination was associated with meaningful albeit modest protection against hospitalisation, particularly in older adults with existing risk factors. Waning immunity and clear reductions in vaccine effectiveness over time were identified, supporting the current Australian national recommendations for booster vaccination limited to select cohorts.

Conclusion and Future actions: Future COVID vaccine recommendations will need to balance the moderate but transient effectiveness of vaccine protection with program delivery and the declining hospitalisation rate.

Background and Aim
Cost-effectiveness analysis guides funding decisions aimed at maximizing health outcomes in Australia and elsewhere. Given the health disparities among people belonging to different socio-economic status (SES), these assessments should also consider equity. This study aimed to conduct an equity-informed economic evaluation of respiratory syncytial virus (RSV) vaccination in those aged ≥75 years in Australia.

Methods and Analysis
We applied a Distributional Cost-Effectiveness Analysis (DCEA) framework to assess the cost-effectiveness and equity impact of RSV vaccination across five socio-economic quintiles. These quintiles were defined using the Index of Relative Socio-economic Disadvantage (IRSD). A static multi-cohort Markov model using monthly cycles was developed to simulate age- and IRSD-specific RSV disease progression, comparing no vaccination with the two currently approved RSV vaccines in Australia (Arexvy and Abrysvo). Net health benefits were calculated considering the opportunity costs for the vaccination program. The equity impact of the vaccination program was evaluated using a social welfare function.

Outcomes
We found that all IRSD subgroups benefited from vaccination with both approved vaccines. However, the more disadvantaged IRSD groups experienced larger health gains because they had a higher baseline risk of RSV-related hospitalisation and death, despite having relatively lower vaccination uptake. At an assumed price of A$150 per vaccine dose and an equal opportunity cost threshold of A$50,000 applied to all IRSD subgroups, we observed an increase in equity and an overall increase in net health benefit under the base-case assumptions for both vaccines. The most influential factors determining the effect of vaccination on net health benefit and equity were annual RSV incidence, probability of symptomatic RSV episode, vaccine efficacies against RSV hospitalisation, and vaccine price.

Conclusion and Future Actions
Vaccinating Australians aged ≥75 years against RSV could improve overall population health and contribute to closing persistent health inequality gaps.

Background and Aim
Respiratory syncytial virus (RSV) is leading cause of healthcare use and mortality among infants and older adults around the world, including in Australia. With the recent approval of adult RSV vaccines in Australia, it is timely to evaluate the potential cost-effectiveness of RSV vaccination in older adults.

Methods and Analysis
We applied a static multi-cohort Markov model to estimate the cost-effectiveness of a single-dose vaccination program for Australians aged ≥75 years with either Arexvy or Abrysvo. Data on RSV epidemiology, healthcare use and associated costs were used as model inputs, and a healthcare system perspective was applied. The primary outcome from the model was the incremental cost-effectiveness ratio per quality-adjusted life year (QALY) gained for RSV vaccination compared to no vaccination.

Outcomes
Assuming a willingness-to-pay (WTP) threshold of A$50,000/QALY gained, an RSV vaccination program for Australians aged ≥75 years was estimated to be cost-effective at a vaccine price less than approximately A$170 for Arexvy and A$180 for Abrysvo, respectively. To be cost-effective at a WTP threshold of A$15,000/QALY gained, Arexvy and Abrysvo needed to be priced below approximately A$100 and A$105, respectively. The majority of the estimated healthcare cost savings (80%–85%) were attributable to preventing RSV hospitalisations, and the majority of the QALY gains were attributed to avoided RSV deaths. The results were most sensitive to the vaccine price, probability of RSV hospitalisation, RSV incidence, and probability of symptomatic RSV episode.

Conclusions and Future actions
An RSV vaccination program for older Australians was estimated to substantially reduced RSV hospitalisations, healthcare costs, and RSV mortality. The cost-effective of an RSV vaccination program in Australians aged ≥75 years was estimated to be dependent on the vaccine price negotiated.

Background and Aim: Respiratory syncytial virus (RSV) is associated with significant morbidity and mortality, particularly for individuals with chronic obstructive pulmonary disease (COPD). Following RSV vaccines approval in August-2024, Denmark introduced conditional reimbursement for the adjuvanted-RSVPreF3 vaccine for adults aged ≥60-years with COPD. We aimed to assess uptake of adjuvanted-RSVPreF3, estimate its effectiveness against RSV hospitalization, and describe other relevant clinical outcomes among Danish adults aged ≥60-years with COPD.

Methods and Analysis: A nationwide Danish cohort study including all adults aged ≥60-years with COPD from 5-August-2024 to 30-April-2025 was conducted to determine adjuvanted-RSVPreF3 vaccine uptake. Vaccinated individuals were matched 1:12 with replacement to unvaccinated individuals. Exact matching on age and sex, and propensity score matching, including region, education, comorbidities, exacerbation history, all-cause hospitalization, and vaccination history were used. Vaccination date was the index date; matched unvaccinated individuals were assigned the same index. Follow-up began 21-days after index date until the earliest of: event of interest, end of data (27-August-2025), migration, receipt of RSV vaccine, or death. Time-to-event analyses used Cox proportional hazards models and K-M estimates. Exact CIs were based on the Poisson distribution (one-sided upper limit for zero events).

Outcomes: Among 126,249 eligible adults with valid data on RSV vaccination, 7,448 (5.9%) received adjuvanted-RSVPreF3 vaccine. Highest uptake (5,852; 79%) was during September-December. The groups were comparable across all covariates after matching with standardized mean differences <0.1. RSV hospitalization rate (95% CI) per 100,000 person-years: vaccinated 0 (0-58) versus unvaccinated 201 (166-241), yielding vaccine effectiveness of 100% (71%-100%). Other relevant clinical outcomes were likewise lower among the vaccinated individuals.

Conclusions and Future Actions: Among adults aged ≥60 with COPD, adjuvanted-RSVPreF3 is highly effective in preventing RSV hospitalizations and RSV-related clinical outcomes (exacerbations and pneumonias). Incorporating the RSV vaccine into routine COPD management could further improve outcomes.

Encore from RSVVW’26

Background and Aim: This study evaluated real-world effectiveness of adjuvanted RSVPreF3 vaccination in preventing respiratory syncytial virus (RSV)-related hospitalisation in US adults aged ≥60 years.

Methods and Analysis: A retrospective cohort study used Optum Research Database claims to evaluate the vaccine effectiveness (VE) of adjuvanted RSVPreF3 against RSV-related hospitalisation. Adults aged ≥60 years were identified between August 2023–May 2024. Vaccinated and unvaccinated patients were exact matched 1:4 by age, sex, insurance type, and state of residence, with index date assigned as the vaccination date. Baseline characteristics were measured during the 12-month pre-index period with continuous enrollment. Patients were followed 14-days post-index to first of disenrollment, death, RSV vaccination, or end of the analysis period. Propensity score-based weighting was used to balance characteristics between vaccinated and unvaccinated groups. Cox proportional hazards regression models estimated hazard ratios overall and prespecified subgroups; VE = (1−hazard ratio) x 100%.

Outcomes: The study included 520,440 vaccinated and 2,081,760 unvaccinated individuals (56.9% female; mean (SD) age 74.3 (6.7) years; Charlson Comorbidity Index 1.4 [1.8]). Median (maximum) follow-up was 5.6 (9.7) months. Estimated overall VE (95% confidence interval) was 75.6% (69.8%–80.2%). Subgroups VE estimates: chronic pulmonary disease 72.5% (64.3%–78.8%), cardiovascular disease 72.2% (64.1%–78.4%), diabetes 82.3% (74.2%–87.9%), and immunocompromised conditions 71.4% (57.0%–81.1%).

Conclusions and Future actions: These real-world evidence results highlighted the effectiveness of the adjuvanted RSVPreF3 vaccination in preventing RSV-related hospitalisation in adults aged ≥60 years, including those with comorbidities, suggesting that vaccination is an effective strategy in reducing disease burden.

Encore from RSVVW’ 2026.