Cell-based flu shots may be more cost-effective, beneficial for pediatric population

Credit: Unsplash / CDC

Cell-based influenza vaccine development and distribution may be more effective for reduced disease burden among children as well as more cost-efficient than egg-based vaccine options, according to findings from a new model analysis.¹

Data derived from a Taiwan-based age-stratified static model interpreting base case and high egg-based vaccine adaptation scenarios predicted that switching from a primary national plan of egg-based vaccines to cell-based vaccines for the flu would significantly reduce the impact of the seasonal virus at a lesser production and distribution cost. The findings warrant consideration toward adopting the model as a vaccination policy specifically for the pediatric population, investigators noted.

Led by Chia-Yu Chi, of the National Institute of Infectious Diseases and Vaccinology under the National Health Research Institutes in Taiwan, the team of investigators designed a prediction model to compare the cost-effectiveness of cell-based versus egg-based quadrivalent flu vaccines in the pediatric population aged 6 months to 17 years old, under Taiwan’s national immunization program. Though cell-based options have been included in the national program since 2020, there had been no previous analysis into its cost-related benefit among the pediatric population—which would help to potentially optimize national vaccination strategies for such children.

“Compared with (egg-based vaccines), cell-based quadrivalent influenza vaccine is anticipated to have improved fidelity to the vaccine strains selected by the World Health Organization (WHO), which, in turn, is expected to result in improved vaccine efficacy,” they wrote. “The vaccine efficacy advantages of (cell-based) may be more pronounced against A/H3N2 and in seasons in which egg adaptation occurs during the egg-based manufacturing process. Several real-world studies also suggest that (cell-based) may be more effective than standard-dose egg-based influenza vaccines in preventing influenza and influenza-related outcomes, particularly in seasons in which egg adaptation occurs, across various age ranges.”

Chi and colleagues’ model exposed patients to different probabilities of flu infection based on model entry-based vaccination status, with assumptions being made that all patients infected with influenza would be initially treated at outpatient facilities or emergency departments (EDs), and that some patients would require inpatient care dependent on infection severity ands risk of death. Their outcomes included total cases of flu, ED visits, flu-related complications, hospitalizations, deaths and quality-adjusted life years (QALYs). Both medical (vaccination and treatment related) and societal costs (relevant transportation, productivity loss, and premature death) were factored into cost outcomes.

The team conducted deterministic and probabilistic sensitivity analyses, with an incremental cost-effective ratio (ICER) threshold of $99,177 USD per QALY.

Their analysis showed that cell-based quadrivalent flu vaccines would prevent 15,665 flu cases, 2244 complicated cases, and 259 hospitalizations annually compared to egg-based quadrivalent flu vaccines.

Though vaccination total costs were approximately $4.5 million USD greater with cell-based vaccines, the model showed the option would save approximately $990,000 USD in treatment costs due to flu infections among pediatric patients annually versus the egg-based vaccine. Regarding societal costs, the cell-based vaccines were predicted to save Taiwan more than $1.4 million USD annually through reduced caregiver, transportation and premature death costs, versus egg-based vaccines.

In combined medical and societal costs, the predictive model suggested cell-based vaccines ($96.6 million USD) would be within approximately $2 million USD annually compared to egg-based vaccines ($94.5 million USD) in treating pediatric influenza in Taiwan annually. The team additionally observed improved QALY (n = 70 annually) with cell-based vaccines versus egg-based vaccines. What’s more, predictive data suggest the medical and economic benefits of a cell-based quadrivalent vaccine would be even greater in seasons with a high egg adaptation observed in the circulating flu strain.

“To the best of our knowledge, this is the first study to compare the cost-effectiveness of (cell-based) versus (egg-based quadrivalent flu vaccines) in the Taiwanese pediatric immunization strategy,” investigators noted. “We have employed valid and effective modeling design that is deemed adequate to assess influenza strategies and our findings appear to be directionally consistent with the conclusions from previously published studies in the general population. Based on our study, universal vaccination with quadrivalent influenza vaccines in the Taiwanese pediatric (6 months to 17 years) population could help reduce the burden of influenza and associated health costs.”

They concluded that national policymakers may want to consider the findings of this and supplementary clinical and economic-based evaluations in their work toward a more optimized pediatric influenza vaccination strategy.

Reference

^{Chi CY, Cheng MF, Ko K, et al. Cost-effectiveness analysis of cell-based versus egg-based quadrivalent influenza vaccines in the pediatric population in Taiwan. J Med Virol. 2024;96(1):e29279. doi:10.1002/jmv.29279}