Potential Cost-Effectiveness of an Influenza Vaccination Program Offering Microneedle Patch for Vaccine Delivery in Children

Abstract

ObjectiveThe influenza vaccine coverage rate of children is low in Hong Kong. Microneedle patches (MNPs) is a technology under development for painless delivery of vaccines. This study aimed to examine the potential clinical outcomes and direct medical costs of an influenza program offering MNP vaccine to children who have declined intramuscular (IM) vaccine in Hong Kong.MethodsA decision model was designed to compare potential outcomes between IM vaccine program and a program offering MNP vaccine to those declined IM vaccine (IM/MNP program) in a hypothetical cohort of children over one-year time horizon. The model outcomes included direct medical cost, influenza infection rate, mortality rate, and quality-adjusted life-years (QALYs) loss. Model inputs were retrieved from published literature. Sensitivity analyses were performed to examine the robustness of model results.ResultsIn base-case analysis, IM/MNP program was more costly per child (USD19.13 versus USD13.69; USD1 = HKD7.8) with lower influenza infection rate (98.9 versus 124.8 per 1,000 children), hospitalization rate (0.83 versus 1.05 per 1,000 children) and influenza-related mortality rate (0.00042 versus 0.00052 per 1,000 children) when compared to IM program. The incremental cost per QALY saved (ICER) of IM/MNP program versus IM program was 27,200 USD/QALY. Using gross domestic product (GDP) per capita of Hong Kong (USD40,594) as threshold of willingness-to-pay (WTP) per QALY, one-way sensitivity analysis found ICER of IM/MNP to exceed WTP when duration of illness in outpatient setting was <5.7 days or cost per MNP vaccine was >1.39-time of IM vaccine cost. In 10,000 Monte Carlo simulations, IM/MNP program was the preferred option in 57.28% and 91.68% of the time, using 1x and 3x GDP per capita as WTP threshold, respectively.ConclusionAcceptance of IM/MNP program as the preferred program was subject to the WTP threshold, duration of illness in outpatient settings, and cost of MNP vaccine.

The potential effects of introducing microneedle patch vaccines into routine vaccine supply chains

“…For TT, which does not come in a single-dose presentation, we used the current price-per-dose plus $1 USD as the lower bound, and the current price-per-dose plus $2 USD as the upper bound. Current literature estimates that the various costs of MNP manufacturing and procurement will be competitive with current vaccine values [22-25]. However, as this technology is not currently manufactured, our price points are meant to capture a wide range of potential prices.…”

Improving pandemic preparedness through better, faster influenza vaccines

“…Innovative vaccine formulation technologies with sustained or pulsed antigen release, recapitulating the kinetics of infection or two injections, have been reported for other diseases and are being considered for clinical development [53,54]. Similarly, alternative delivery, such as microneedle patch technology or intranasal/oral formulations, would also alleviate this operational barrier, allow for improved delivery options, and minimize the need for trained health care professionals [55][56][57].…”

Current and future technological advances in transdermal gene delivery

“…3d-e) [10]. Compared with other physical approaches, this technique is simple and cost-effective, without needing expensive devices [108][109][110][111][112]. This method also induces minimal pain and tissue damage and has the potential of self-administration.…”