Impact of quadrivalent influenza vaccines in Brazil: a cost-effectiveness analysis using an influenza transmission model.
Pascal Crépey, Louis Boiron, Rafael Rodrigo Araujo, Juan Guillermo Lopez, Audrey Petitjean, Expedito José de Albuquerque Luna
Author Information
Pascal Crépey: Department of Quantitative Methods in Public Health, UPRES-EA-7449 Reperes, EHESP, University of Rennes, 15 Av. Professeur Léon Bernard, 35043, Rennes, France.
Louis Boiron: Sanofi Pasteur, Av. das Nações Unidas, 14410 - Condomínio Parque da Cidade Torre Sucupira, Jardim Morumbi - CEP, São Paulo, SP, 04794-000, Brazil. louis.boiron@sanofi.com. ORCID
Rafael Rodrigo Araujo: Sanofi Pasteur, Av. das Nações Unidas, 14410 - Condomínio Parque da Cidade Torre Sucupira, Jardim Morumbi - CEP, São Paulo, SP, 04794-000, Brazil.
Juan Guillermo Lopez: Sanofi Pasteur, Av. Universidad 1738, Santa Catarina, Coyoacán, 04000 Ciudad de México, CDMX, Mexico.
Audrey Petitjean: Sanofi Pasteur, 14 Espace Henry Vallée, 69007, Lyon, France.
Expedito José de Albuquerque Luna: Institute of Tropical Medicine (IMT) - University of São Paulo (USP), Av. Dr. Enéas Carvalho de Aguiar, 470 - Jardim America - CEP, São Paulo, SP, 05403-000, Brazil.
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.
