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Impact of quadrivalent influenza vaccines in Brazil: a cost-effectiveness analysis using an influenza transmission
Pascal Crépey1, Louis Boiron2, Rafael Rodrigo Araujo3
1Department of Quantitative Methods in Public Health, UPRES-EA-7449 Reperes, EHESP, University of Rennes, 15 Av. Professeur Léon Bernard, 35043, Rennes, France.
Insights
Switching to quadrivalent influenza vaccine (QIV) for children in Brazil could prevent hundreds of thousands of cases and nearly 400 deaths annually. This public health strategy is cost-effective, saving lives and reducing healthcare burdens.
Area of Science:
- Public Health
- Epidemiology
- Health Economics
Background:
- Influenza epidemics pose a significant burden on Brazil's healthcare system and society.
- Pediatric vaccination against influenza is increasingly recommended, but trivalent influenza vaccine (TIV) strain mismatch remains a concern.
- Quadrivalent influenza vaccines (QIV) enhance effectiveness by covering both B lineages, mitigating potential mismatches.
Purpose of the Study:
- To evaluate the public health and economic benefits of switching from TIV to QIV for pediatric influenza vaccination in Brazil (ages 6 months to 5 years).
- To assess the indirect impact of vaccination using a dynamic epidemiological model and a health-economic model adapted to the Brazilian context.
Main Methods:
- Utilized a dynamic epidemiological model to simulate influenza transmission and the impact of vaccination.
- Integrated epidemiological model results into a health-economic model for cost-effectiveness analysis.
- Conducted deterministic and probabilistic sensitivity analyses to address epidemiological and economic uncertainties.
Main Results:
- The switch to QIV is projected to prevent 406,600 symptomatic cases, 11,300 hospitalizations, and nearly 400 deaths per influenza season.
- This strategy could save 3400 life-years annually, with incremental costs ranging from R$169 million (public payer) to R$86 million (societal perspective).
- Incremental cost-effectiveness ratios were R$49,700 per life-year saved and R$26,800 per quality-adjusted life-year gained from a public payer perspective.
Conclusions:
- Switching to QIV for children aged 6 months to 5 years in Brazil offers substantial public health benefits.
- The strategy is cost-effective for public payers and highly cost-effective from a societal perspective.
- QIV implementation represents an efficient approach to mitigate the impact of influenza in the Brazilian pediatric population.
Background:
Influenza epidemics significantly weight on the Brazilian healthcare system and its society. Public health authorities have progressively expanded recommendations for vaccination against influenza, particularly to the pediatric population. However, the potential mismatch between the trivalent influenza vaccine (TIV) strains and those circulating during the season remains an issue. Quadrivalent vaccines improves vaccines effectiveness by preventing any potential mismatch on influenza B lineages.
Methods:
We evaluate the public health and economic benefits of the switch from TIV to QIV for the pediatric influenza recommendation (6mo-5yo) by using a dynamic epidemiological model able to consider the indirect impact of vaccination. Results of the epidemiological model are then imputed in a health-economic model adapted to the Brazilian context. We perform deterministic and probabilistic sensitivity analysis to account for both epidemiological and economical sources of uncertainty.
Results:
Our results show that switching from TIV to QIV in the Brazilian pediatric population would prevent 406,600 symptomatic cases, 11,300 hospitalizations and almost 400 deaths by influenza season. This strategy would save 3400 life-years yearly for an incremental direct cost of R$169 million per year, down to R$86 million from a societal perspective. Incremental cost-effectiveness ratios for the switch would be R$49,700 per life-year saved and R$26,800 per quality-adjusted life-year gained from a public payer perspective, and even more cost-effective from a societal perspective. Our results are qualitatively similar in our sensitivity analysis.
Conclusions:
Our analysis shows that switching from TIV to QIV to protect children aged 6mo to 5yo in the Brazilian influenza epidemiological context could have a strong public health impact and represent a cost-effective strategy from a public payer perspective, and a highly cost-effective one from a societal perspective.
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