A cost-effectiveness analysis of reduced viral transmission with baloxavir marboxil versus oseltamivir or no treatment for seasonal and pandemic influenza management in the United Kingdom

ABSTRACT

Background

Baloxavir marboxil is an oral, single-dose, cap-dependent endonuclease inhibitor that reduces the duration of influenza symptoms and rapidly stops viral shedding. We developed a susceptible, exposed, infected, recovered (SEIR) model to inform a cost-effectiveness model (CEM) of baloxavir versus oseltamivir or no antiviral treatment in the UK.

Research design and methods

The SEIR model estimated the attack rates among otherwise healthy and high-risk individuals in seasonal and pandemic settings. The CEM assumed that a proportion of infected patients would receive antiviral treatment. Results were reported at the population level (per 10,000 at risk of infection).

Results

The SEIR model estimated greater reductions in infections with baloxavir. In a seasonal setting, baloxavir provided incremental cost-effectiveness ratios (ICERs) of £1884 per quality-adjusted life-year (QALY) gained versus oseltamivir and a dominant cost-effectiveness position versus no antiviral treatment in the total population; ICERs of £2574/QALY versus oseltamivir and £128/QALY versus no antiviral treatment were seen in the high-risk population. Baloxavir was also cost-effective versus oseltamivir or no antiviral treatment and reduced population-level health system occupancy concerns during a pandemic.

Conclusion

Baloxavir treatment resulted in the fewest influenza cases and was cost-effective versus oseltamivir or no antiviral treatment from a UK National Health Service perspective.

Plain Language Summary

Baloxavir marboxil (‘baloxavir’) is a prescription medicine for people who become ill with influenza (or ‘the flu’) that can reduce how long flu symptoms last and the likelihood of complications from the flu that may require going to the hospital. Baloxavir can also reduce the amount and duration of virus shed by infected individuals thus potentially slow or stop the flu from spreading to healthy people. We studied differences in reducing predicted flu infections between baloxavir and another flu treatment, known as oseltamivir, or no flu treatment at all. Treatment with baloxavir resulted in fewer flu infections in the UK population than oseltamivir or no treatment. We then studied how these differences might affect costs between baloxavir and oseltamivir or no treatment at a population level in the UK. Overall, in the majority of scenarios explored in the model, baloxavir was cost-effective as an antiviral treatment for people with the flu in the UK.

KEYWORDS:

• Antiviral treatment
• baloxavir marboxil
• cost-effectiveness
• influenza
• oseltamivir
• United Kingdom

Declaration of interest

S. A. Kommandantvold, A. Lemenuel-Diot, P. Rouse, H. Zaraket, and M.-H. Blanchet Zumofen are employees and stockholders of F. Hoffmann-La Roche, Ltd. H. Zhou is an employee of Genentech Inc, a member of the Roche Group, and a stockholder of F. Hoffmann-La Roche, Ltd. C. Skedgel is an employee of the Office of Health Economics (OHE) Ltd., which has received funding from a variety of sources, including F. Hoffmann-La Roche Ltd., and members of the Roche Group. R. Pitman is an employee of ICON plc, which received funding for this study from F. Hoffmann-La Roche Ltd. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Acknowledgments

This study was supported by F. Hoffmann-La Roche, Ltd. Third-party writing assistance was furnished by Jeff Frimpter, MPH, of Health Interactions, Inc, funded by F. Hoffmann-La Roche, Ltd. Part of this work was presented at the Ninth European Scientific Working Group on Influenza (ESWI) Conference, September 17-20, 2023, in Valencia, Spain.

Author contributions

Concept and design: SA Kommandantvold, A Lemenuel-Diot, C Skedgel, R Pitman, P Rouse, H Zhou, and M-H Blanchet Zumofen. Analysis and interpretation of the data: All authors. Drafting of the manuscript or critical revision for intellectual content: All authors. Final approval of the manuscript to be published: All authors. All authors take responsibility and agree to be accountable for all aspects of this work.

Data availability statement

The data supporting the findings of this study are available within the article and its supplementary materials.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary Material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737167.2024.2365421

Additional information

Funding

This manuscript was funded by F. Hoffmann-La Roche, Ltd.