Should Canadian seniors get the RSV vaccine? What the latest study says about cost and benefits

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With the arrival of new vaccines for respiratory syncytial virus (RSV), Canadian seniors are faced with a critical decision: Is it worth getting the shot, especially if it’s not covered by public health insurance?

RSV is a common respiratory virus that usually causes a mild illness with cold-like symptoms and "follows an annual seasonal pattern." In Canada, it’s most active between fall and early spring.

While it commonly causes mild illness, RSV can lead to serious infection including bronchiolitis and pneumonia, which infants and seniors are most at-risk of.

A recent study on the cost-effectiveness of RSV vaccination strategies in older Canadians offers some insights on who exactly needs the vaccine, whether it’s covered by insurance or not. Here’s what you need to know.

What does the study say about RSV vaccines for seniors?

The study, published in the Canadian Medical Association Journal (CMAJ), evaluated different vaccination strategies for older adults, focusing on age-based and medical risk-based approaches.

The researchers found that RSV vaccines could significantly reduce the burden of disease and associated healthcare costs — but not all groups would benefit equally from a publicly funded program.

Ashleigh Tuite, one of the study’s authors and an infectious disease epidemiologist, explained: “RSV vaccines do have the potential to reduce healthcare and related costs for Canadians, but in particular, the vaccines or a vaccination program would be most cost-effective in older adults… who have underlying medical conditions that may place them at increased risk of having severe disease if they were to be infected with RSV.”

The study found that the most cost-effective strategy is vaccinating adults who are both:

• Aged 70 and older

• With at least one chronic medical condition (chronic obstructive pulmonary disease, congestive heart failure, diabetes, asthma, or immunodeficiency)

While vaccinating all seniors regardless of health status could still prevent disease, it was deemed less efficient in terms of healthcare spending.

How much does the RSV vaccine cost?

The RSV vaccine can cost between $200 and $350 if paid out-of-pocket, depending on your province or territory, the CBC previously reported.

Currently, Ontario is the only province publicly funding the RSV vaccine for some people over 60, specifically those living in long-term care homes, elder care and some retirement homes licensed to provide dementia care services.

Other provinces are awaiting further guidance from the National Advisory Committee on Immunization (NACI) before deciding whether to include the RSV vaccine in their publicly funded programs.

Who should consider getting the RSV shot?

Even if the RSV vaccine isn’t covered by your provincial healthcare plan, many experts still recommend it, especially for seniors with specific health risks. But, anyone over 60 can benefit from the vaccine.

“Who would like to have the severe complication of respiratory infection? Of course, nobody does. And with our resource-strained healthcare system, we should do our best to avoid having anyone hospitalized," Wasem Alsabbagh, a professor at the University of Waterloo School of Pharmacy, noted.

Alsabbagh highlighted the serious consequences of RSV, saying, “Imagine a senior in your life — maybe a parent or grandparent — who suddenly faces life-threatening complications from a disease we can prevent.” Seniors should consult their primary care provider, he added.

What are the costs and benefits of the RSV vaccine for different groups?

The cost-effectiveness of the RSV vaccine depends on your age and health status. Dr. Samir Sinha, director of geriatrics at the University Health Network in Toronto, said the study’s findings are particularly relevant for governments and insurers when deciding who should receive the vaccine for free.

“This paper said if you're 70 or older, had at least one or more chronic conditions, then it's probably worth it for governments to actually fund this for you,” Sinha explained.

For individuals, the decision often comes down to weighing the personal cost against the potential health benefits. Sinha recommended that his patients get vaccinated against RSV, especially since the virus can cause complications similar to influenza.

“If my older patients can afford it, I'd say absolutely pay for it because, at the end of the day, the person who cares most about your future quality of life is you,” he said.

Sinha also pointed out the challenges many seniors face with the high cost of the vaccine, stating, “The real challenge that I have in my practice is I have a lot of older patients who would be eligible for this, but currently because it's not covered, they won't get it because it's too costly for them, especially with the living crisis that we have right now.”

What should seniors do if the RSV vaccine is not covered?

For seniors who are unsure about paying for the vaccine out-of-pocket, experts suggest discussing it with their healthcare provider.

Alsabbagh advised weighing the benefits against the risks and costs. “Put those two into perspective, the benefits and risks, and costs, and then make an informed decision,” he said. The potential for protection from severe RSV infection might outweigh the financial cost, especially for those with existing health conditions.

Sinha echoed this advice and emphasized the importance of personal decision-making: “I would say to any of my patients that just because it's not cost-effective for the government, doesn't mean that it won't be cost-effective for you individually. I still think it's an excellent vaccine.”

What changes might we see in RSV vaccine coverage?

Currently, many provincial and territorial health authorities are waiting for guidance from NACI before deciding on publicly funded RSV vaccination programs. The study’s findings could influence these decisions, potentially expanding coverage to those aged 70 and older with at least one chronic condition.

Sinha hopes that as more evidence becomes available, “there is enough evidence now… that there are populations that should have this given to them at least free of charge.”

He also stressed the impact of broader public funding: “Once you make something freely available, you're going to significantly improve uptake of it as well.”

The bottom line

If you’re a senior wondering whether to get the RSV vaccine, consider your personal health risks and consult with your doctor.

While the vaccine’s cost may be a barrier for some, its potential to prevent serious illness could make it a worthwhile investment in your health, especially if you are over 70 or have chronic health conditions.

Sinha’s advice is clear: “I would highly recommend that they get the vaccine.”

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