Abstract
Non-egg-based influenza vaccines eliminate the potential for egg-adapted mutations and potentially increase vaccine effectiveness. This retrospective study compared hospitalizations/emergency room (ER) visits and all-cause annualized healthcare costs among subjects aged 4–64 years who received cell-based quadrivalent (QIVc) or standard-dose egg-based quadrivalent (QIVe-SD) influenza vaccine during the 2018–19 influenza season. Administrative claims data (IQVIA PharMetrics® Plus, IQVIA, USA) were utilized to evaluate clinical and economic outcomes. Adjusted relative vaccine effectiveness (rVE) of QIVc vs. QIVe-SD among overall cohort, as well as for three subgroups (age 4–17 years, age 18–64 years, and high-risk) was evaluated using inverse probability of treatment weighting (IPTW) and Poisson regression models. Generalized estimating equation models among the propensity score matched sample were used to estimate annualized all-cause costs. A total of 669,030 recipients of QIVc and 3,062,797 of QIVe-SD were identified after IPTW adjustments. Among the overall cohort, QIVc had higher adjusted rVEs against hospitalizations/ER visits related to influenza, all-cause hospitalizations, and hospitalizations/ER visits associated with any respiratory event compared to QIVe-SD. The adjusted annualized all-cause total costs were higher for QIVe-SD compared to QIVc ((+$461); p < 0.05).
Highlights
Annual influenza exerts a significant clinical and economic burden on the health care system in the United States (U.S.)
Clinical outcomes included hospitalizations/emergency room (ER) visits related to influenza (ICD-9 487x, 488 x, ICD-10 J09 x, J10 x, J11 x), hospitalizations/ER visits related to respiratory events including pneumonia, asthma/COPD/bronchial events, and any respiratory event (ICD-9-CM 460 x -519 x; ICD-10-CM: J x x), and all-cause hospitalizations
We found that during the 2018–19 influenza season, QIVc was associated with a significant protective benefit against pneumonia-related hospitalizations/ER visits for the 4–17 age group only
Summary
Annual influenza exerts a significant clinical and economic burden on the health care system in the United States (U.S.). The constant mutation of the influenza virus requires annual vaccination for optimal protection. Various factors, including the antibody response to vaccines depending on the human immune system, a mismatch between the circulating virus strain and the vaccine virus strain, and egg adaptation associated with egg-based vaccine production, can affect the effectiveness of vaccines in protecting against influenza. Egg-based manufacturing methods can select viruses with adaptive mutations acquired for growth [5,6]. These selected egg-based changes can cause a mismatch between the vaccine virus strains and the circulating viruses reducing the specificity of the immune response to the circulating viruses
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