Cost‐effectiveness analysis of cell‐based versus egg‐based quadrivalent influenza vaccines in the pediatric population in Taiwan

Abstract

Cell‐based influenza vaccines avoid egg‐adaptive mutations, potentially improving vaccine effectiveness. We assessed the one‐season cost‐effectiveness of cell‐based quadrivalent influenza vaccine (QIVc) against that of egg‐derived quadrivalent influenza vaccines (QIVe) in children (6 months to 17 years of age) from payer and societal perspectives in Taiwan using an age‐stratified static model. Base case and high egg adaptation scenarios were assessed. Deterministic and probabilistic sensitivity analyses were performed. The incremental cost‐effectiveness ratio (ICER) threshold in Taiwan was assumed to be USD 99 177/quality‐adjusted life year (QALY). Compared to QIVe, QIVc would prevent 15 665 influenza cases, 2244 complicated cases, and 259 hospitalizations per year. The base case ICER was USD 68 298/QALY and USD 40 085/QALY from the payer and societal perspective, respectively. In the high egg adaptation scenario, the ICER was USD 45 782/QALY from the payer's perspective and USD 17 489/QALY from the societal perspective. Deterministic sensitivity analyses indicated that infection incidence rate, vaccination coverage, and prevalence of the A/H3N2 strain were the main drivers of ICER. In conclusion, switching the immunization strategy from QIVe to QIVc is predicted to reduce the influenza‐associated disease burden and be cost‐effective for the pediatric population in Taiwan. The potential benefits of QIVc would be even higher during influenza seasons with high levels of egg adaptation.

The economic rationale for cell-based influenza vaccines in children and adults: A review of cost-effectiveness analyses

“…Sensitivity analysis shows that this vaccine combination would be favorable in nearly all scenarios Nguyen et al, 2021 32 United States Adults 18–64 years of age Compared with QIVe for the entire population, the authors estimated the CE of QIVc in those 18–64 years of age Dynamic age-structured SEIR transmission model Societal 3 years QIVe = $17.22QIVc = $24.22 Hospitalization, GP visit Lostwork days US Dollar ($), year not reported QIVc versus QIVe was 26.8% (95% CI: 14–37) 26 Life years and QALYs lost were discounted PSA QIVc was dominant (ICER –$10,400/QALY). Base case scenario assumed 3 years of mismatch out of 5 years QIVc was more effective and cost-saving than QIVe, validated by sensitivity analyses Chi et al, 2023 33 Taiwan Children and adolescents 6 months–17 years of age Replacing QIVe with QIVc in children and adolescents 6 months–17 years of age 1-year age-stratified static decision tree Payer and societal perspective (two base case analyses) 1 year QIVc unit cost assumed 25% higher than QIVe Outpatient, ER visit, hospitalization, transportation costs Loss of productivity US Dollar ($), 2022 QIVc versus QIVe against all influenza strains was 8.1% 34 3% annualized inflation rate applied DSA and PSA ICER was $68,298/QALY and $40,085/QALY from payer and societal perspectives, respectively. WTP threshold was $99,177/QALY Switching from QIVe to QIVc in Taiwanese children and adolescents is predicted to significantly reduce the influenza-associated disease burden and be cost-effective in Taiwan.…”

“…Estimates of rVE of QIVc versus QIVe applied in the CEA studies ranged from 8.1% to 36.2%, with a trend toward lower estimates applied in more recent CEAs. The three most recent CEAs used rVE data from meta-analysis estimates, 33–35 and several other analyses included a base case rVE point estimate originating from the 2017–2018 egg-adapted season 25 , 27 , 29 , 30 , 32 ( Table 2 ), which was characterized as a high-severity season with documented evidence of egg-adapted mutations in the egg-based vaccine A(H3N2) strain dominated by A(H3N2) and B strains.…”

“…CEAs are highly sensitive to estimates of benefit, such as rVE inputs. 33 , 40 , 41 The WHO recommends the use of VE estimates from systematic reviews or meta-analyses, or a range of values, subject to sensitivity analyses representative of extreme circumstances. 33 , 40 , 42 , 43 Best available rVE estimates should be inputted into CEA models, and, depending on local needs, a range of rVE values can be justified with respect to WHO guidance.…”

“…Findings of cost-effectiveness of QIVc over QIVe are not surprising, considering rVE estimates favoring QIVc from rigorous sources, such as meta-analyses, large RWE studies including multiple seasons, and test-negative designs. 34 , 38 , 43 , 48–51 Meta-analysis data used in three CEAs 33–35 summarized the rVE of QIVc versus QIVe against influenza-related medical encounters as 8.1% in children ≥4 years of age and 11.4% in adults based on four studies. 34 In RWE studies, the rVE of QIVc versus QIVe for the prevention of influenza-related hospitalizations/emergency room visits was 14.4%, 6.5%, and 5.3% in children and adults for the 2017–2018, 2018–2019, and 2019–2020 influenza seasons, respectively.…”