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Evaluating the Public Health and Health Economic Impacts of Baloxavir Marboxil and Oseltamivir for Influenza Pandemic Control in China: A Cost-Effectiveness Analysis Using a Linked Dynamic Transmission–Economic Evaluation Model

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Abstract

Background

Pandemic influenza poses a recurring threat to public health. Antiviral drugs are vital in combating influenza pandemics. Baloxavir marboxil (BXM) is a novel agent that provides clinical and public health benefits in influenza treatment.

Methods

We constructed a linked dynamic transmission-economic evaluation model combining a modified susceptible–exposed–infected–recovered (SEIR) model and a decision tree model to evaluate the cost-effectiveness of adding BXM to oseltamivir in China’s influenza pandemic scenario. The cost-effectiveness was evaluated for the general population from the Chinese healthcare system perspective, although the users of BXM and oseltamivir were influenza-infected persons. The SEIR model simulated the transmission dynamics, dividing the population into four compartments: susceptible, exposed, infected, and recovered, while the decision tree model assessed disease severity and costs. We utilized data from clinical trials and observational studies in the literature to parameterize the models. Costs were based on 2021 CN¥ and not discounted due to a short time-frame of one year in the model. One-way, two-way, and probabilistic sensitivity analyses were also conducted.

Results

The integrated model demonstrated that adding BXM to treatment choices reduced the cumulative incidence of infection from 49.49% to 43.26% and increased quality-adjusted life years (QALYs) by 0.00021 per person compared with oseltamivir alone in the base-case scenario. The intervention also amounted to a positive net monetary benefit of CN¥77.85 per person at the willingness to pay of CN¥80,976 per QALY. Sensitivity analysis confirmed the robustness of these findings, with consistent results across varied key parameters and assumptions.

Conclusions

Adding BXM to treatment choices instead of only treating with oseltamivir for influenza pandemic control in China appears to be cost-effective compared with oseltamivir alone. The dual-agent strategy not only enhances population health outcomes and conserves resources, but also mitigates influenza transmission and alleviates healthcare burden.

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Author information

Author notes

  1. Yawen Jiang and Jiaxin Wen contributed equally to the submitted work.

Authors and Affiliations

  1. School of Public Health (Shenzhen), Sun Yat-sen University, 66 Gongchang Rd, Guangming District, Shenzhen, Guangdong, China

    Yawen Jiang, Jiatong Sun & Yuelong Shu

  2. Gusu District Center for Disease Control and Prevention, Suzhou, Jiangsu, China

    Jiaxin Wen

  3. Institute of Pathogen Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Bei**g, China

    Yuelong Shu

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Correspondence to Yawen Jiang or Yuelong Shu.

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Ethics approval

The study was based on simulation. Therefore, ethical approvals were not applicable.

Funding

This work was supported by Guangdong Basic and Applied Basic Research Foundation (2021A1515220170) and F. Hoffmann-La Roche Ltd. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author contributions

Y.J. and Y.S. conceived the study and secured funding. Y.J. and J.W. reviewed the literature, constructed the model, and analyzed the data. Y.J., J.W., and J.S. interpreted the data and drafted the manuscript. Y.S. reviewed and critically revised the paper. J.S. provided administrative and logistic support. All authors gave final approval for publication.

Data and availability

The data used in the study are provided in the manuscript. The modeling file and the data used in the model have been submitted for editorial and peer review and is available online. (https://drive.google.com/file/d/1CerINWYrm9HSY5Uaaz2a5GwI1vRLdyIq/view?usp=sharing).

Competing interests

Y.J. and Y.S. received research funding from F. Hoffmann-La Roche Ltd and Sanofi Pasteur. J.W. and J.S. declare they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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Jiang, Y., Wen, J., Sun, J. et al. Evaluating the Public Health and Health Economic Impacts of Baloxavir Marboxil and Oseltamivir for Influenza Pandemic Control in China: A Cost-Effectiveness Analysis Using a Linked Dynamic Transmission–Economic Evaluation Model. PharmacoEconomics (2024). https://doi.org/10.1007/s40273-024-01412-9

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