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Research article
Van Hung Nguyen
VHN consulting
Corresponding Author
ORCiD: https://orcid.org/0000-0002-0371-0193
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Mutations of the H3N2 vaccine strain during the egg-based vaccine manufacturing process seem to partly explain the suboptimal effectiveness of traditional seasonal influenza vaccine. Cell-based influenza vaccines avoid such egg-adaptation, thereby improving antigenic match and vaccine effectiveness. The objective of this study was to evaluate the public health and economic impact of a cell-based quadrivalent influenza vaccine (QIVc) in adult population (18-64 years) compared to the standard egg-based quadrivalent influenza vaccine (QIVe), in the US.
Methods: The impact of QIVc over QIVe in terms of public health and costs outcomes was estimated using a dynamic SEIR transmission model. The model is age-structured and accounts for 4 circulating influenza strains (A/H1N1pdm9, A/H3N2, B(Victoria), and B(Yamagata)). It was calibrated on US attack rate and strain circulation for the influenza seasons 2013-2018. US specific absolute vaccine effectiveness for QIVe, specific hospitalization rate, mortality rate, Quality-Adjusted Life Years (QALYs) and costs were extracted from published literature. Relative vaccine effectiveness of QIVc over QIVe for subjects 18-64 years of age was obtained from a US retrospective cohort study. Robustness of the results was assessed in univariate and probabilistic sensitivity analyses.
Results: Switching from QIVe to QIVc in the 18-64 year-old population may prevent 5.7 M symptomatic cases, 1.8 M outpatient visits; 50K hospitalizations and 5,453 deaths annually. The switch could save 128 K QALYs and US$ 845M in direct costs, resulting in a cost-saving alternative in a 3-year time horizon analysis. Probabilistic sensitivity analyses confirmed the robustness of the cost-saving result.
Conclusions: The analysis shows that QIVc is expected to prevent a substantial number of hospitalizations and deaths, and would result in substantial savings in health care costs.
Keywords
Influenza, cost-effectiveness, Quadrivalent Influenza Vaccine, cell-based influenza vaccine, US
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CURRENT STATUS: Under Review
Version 2
Posted 09 Sep, 2020
No community comments so far
Editorial decision: Withdrawn by author
On 10 Mar, 2021
Review #2 received
Received 14 Oct, 2020
Reviewer #2 agreed
On 23 Sep, 2020
Reviewers invited
Invitations sent on 01 Sep, 2020
Reviewer #1 agreed
On 01 Sep, 2020
Review #1 received
Received 01 Sep, 2020
Editor assigned
On 31 Aug, 2020
Submission checks complete
On 30 Aug, 2020
Editor invited
On 30 Aug, 2020
No comments provided
Editorial decision: Major revision
On 16 Jun, 2020
Review #2 received
Received 09 Jun, 2020
Review #1 received
Received 29 May, 2020
Reviewer #2 agreed
On 23 May, 2020
Reviewer #1 agreed
On 21 May, 2020
Reviewers invited
Invitations sent on 20 May, 2020
Editor assigned
On 12 May, 2020
Submission checks complete
On 11 May, 2020
Editor invited
On 11 May, 2020
First submitted
On 08 May, 2020
Version (no preprint)
Posted 21 May, 2020
Editorial decision: Major revision
On 11 Aug, 2020
Editor assigned
On 12 Jul, 2020
Submission checks complete
On 11 Jul, 2020
Editor invited
On 11 Jul, 2020
This version was not preprinted
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This preprint is under consideration at BMC Public Health. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Van Hung Nguyen
VHN consulting
Corresponding Author
ORCiD: https://orcid.org/0000-0002-0371-0193
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 2
Posted 09 Sep, 2020
No community comments so far
Editorial decision: Withdrawn by author
On 10 Mar, 2021
Review #2 received
Received 14 Oct, 2020
Reviewer #2 agreed
On 23 Sep, 2020
Reviewers invited
Invitations sent on 01 Sep, 2020
Reviewer #1 agreed
On 01 Sep, 2020
Review #1 received
Received 01 Sep, 2020
Editor assigned
On 31 Aug, 2020
Submission checks complete
On 30 Aug, 2020
Editor invited
On 30 Aug, 2020
No comments provided
Editorial decision: Major revision
On 16 Jun, 2020
Review #2 received
Received 09 Jun, 2020
Review #1 received
Received 29 May, 2020
Reviewer #2 agreed
On 23 May, 2020
Reviewer #1 agreed
On 21 May, 2020
Reviewers invited
Invitations sent on 20 May, 2020
Editor assigned
On 12 May, 2020
Submission checks complete
On 11 May, 2020
Editor invited
On 11 May, 2020
First submitted
On 08 May, 2020
Version (no preprint)
Posted 21 May, 2020
Editorial decision: Major revision
On 11 Aug, 2020
Editor assigned
On 12 Jul, 2020
Submission checks complete
On 11 Jul, 2020
Editor invited
On 11 Jul, 2020
This version was not preprinted
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Mutations of the H3N2 vaccine strain during the egg-based vaccine manufacturing process seem to partly explain the suboptimal effectiveness of traditional seasonal influenza vaccine. Cell-based influenza vaccines avoid such egg-adaptation, thereby improving antigenic match and vaccine effectiveness. The objective of this study was to evaluate the public health and economic impact of a cell-based quadrivalent influenza vaccine (QIVc) in adult population (18-64 years) compared to the standard egg-based quadrivalent influenza vaccine (QIVe), in the US.
Methods: The impact of QIVc over QIVe in terms of public health and costs outcomes was estimated using a dynamic SEIR transmission model. The model is age-structured and accounts for 4 circulating influenza strains (A/H1N1pdm9, A/H3N2, B(Victoria), and B(Yamagata)). It was calibrated on US attack rate and strain circulation for the influenza seasons 2013-2018. US specific absolute vaccine effectiveness for QIVe, specific hospitalization rate, mortality rate, Quality-Adjusted Life Years (QALYs) and costs were extracted from published literature. Relative vaccine effectiveness of QIVc over QIVe for subjects 18-64 years of age was obtained from a US retrospective cohort study. Robustness of the results was assessed in univariate and probabilistic sensitivity analyses.
Results: Switching from QIVe to QIVc in the 18-64 year-old population may prevent 5.7 M symptomatic cases, 1.8 M outpatient visits; 50K hospitalizations and 5,453 deaths annually. The switch could save 128 K QALYs and US$ 845M in direct costs, resulting in a cost-saving alternative in a 3-year time horizon analysis. Probabilistic sensitivity analyses confirmed the robustness of the cost-saving result.
Conclusions: The analysis shows that QIVc is expected to prevent a substantial number of hospitalizations and deaths, and would result in substantial savings in health care costs.
Figure 1
Figure 2
Figure 3
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