The potential cost-effectiveness of next generation influenza vaccines in England and Wales: A modelling analysis

Next generation influenza vaccines are in development and have the potential for widespread health and economic benefits. Determining the potential health and economic impact for these vaccines is needed to drive investment in bringing these vaccines to the market, and to inform which groups public health policies on influenza vaccination should target.We used a mathematical modelling approach to estimate the epidemiological impact and cost-effectiveness of next generation influenza vaccines in England and Wales. We used data from an existing fitted model, and evaluated new vaccines with different characteristics ranging from improved vaccines with increased efficacy duration and breadth of protection, to universal vaccines, defined in line with the World Health Organisation (WHO) Preferred Product Characteristics (PPC). We calculated the cost effectiveness of new vaccines in comparison to the current seasonal vaccination programme. We calculated and compared the Incremental Cost-Effectiveness Ratio and Incremental Net Monetary Benefit for each new vaccine type. All analysis was conducted in R.We show that next generation influenza vaccines may result in a 21% to 77% reduction in influenza infections, dependent on vaccine characteristics. Our economic modelling shows that using any of these next generation vaccines at 2019 coverage levels would be highly cost-effective at a willingness to pay threshold of 20,000 pound for a range of vaccine prices. The vaccine threshold price for the best next generation vaccines in -2019 pound is 230 pound (95% CrI 192 pound -269) pound per dose, but even minimally-improved influenza vaccines could be priced at 18 pound (95%CrI 16 pound -21) pound per dose and still remain cost-effective.This evaluation demonstrates the promise of next generation influenza vaccines for impact on influenza epidemics, and likely costeffectiveness profiles. We have provided evidence towards a full value of vaccines assessment which bolsters the investment case for development and rollout of next-generation influenza vaccines.