Cost-effectiveness analysis of baloxavir marboxil versus oseltamivir for seasonal influenza treatment in China

Fangyu Zheng¹Yuekun Tang^1,2Hongli Jiang^1*

• ¹Fudan University School of Public Health, Shanghai, China
• ²Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China

Objectives: This study aimed to evaluate the cost-effectiveness of baloxavir marboxil versus oseltamivir for treating seasonal influenza among both high-risk and otherwise healthy populations in China from the healthcare system perspective. Methods: A decision tree model was constructed to evaluate the cost-effectiveness of two drugs. This model was integrated with a transmission dynamics model to assess the impact on controlling influenza spread. Model parameters for epidemiology, costs, and utilities were derived from real-world data on treatment costs from secondary and tertiary hospitals across China, the phase III clinical trial of baloxavir (CAPSTONE), and published literature. Results: Baloxavir was found to be a dominant strategy compared to oseltamivir in both populations, yielding lower costs and higher QALYs. For high-risk population, baloxavir treatment would save $2.5914 per patient and gain an additional 0.00018 QALYs. And for the otherwise healthy population it would save $1.1263 per patient and gain an additional 0.00024 QALYs. One-way sensitivity analysis identified QALYs for influenza and hospitalization costs as the most influential parameters for the high-risk population, while the number of infections, ICU fatality rate, and hospitalization costs were key drivers for the otherwise healthy population. Probabilistic sensitivity analysis confirmed the robustness of these findings. Conclusion: Baloxavir is a cost-effective alternative to oseltamivir for seasonal influenza treatment in China. It can improve patient outcomes and reduce influenza transmission at a societal level, offering value to the healthcare system.