OBJECTIVES: To estimate the cost-effectiveness of baloxavir barboxil versus oseltamivir in high-risk adults and otherwise healthy adults in China from the payer perspective.

METHODS: The one-year decision tree was used to evaluate costs and outcomes as quality-adjusted life-years (QALYs). Direct medical costs of 1,997 outpatients with influenza like illness and 384 influenza related inpatients were collected from Chinese hospitals. Clinical outcomes were quoted from phase III clinical trials of baloxavir and other epidemiological parameters from available literatures. According to the clinical trials and life expectancy in China, baloxavir used in high risk patients averting one case of premature death were calculated by 13.2 QALYs. Since influenza is an infectious disease, a transmission dynamics model was leveraged to estimate the spread of the disease in Chinese population and the protection rate of baloxavir to avoid influenza transmission. Sensitivity analysis were conducted to verify the robustness of the results.

RESULTS: Considering the transmission dynamics model, the ICER of baloxavir was dominant in high risk adults, and CNY 52,704.98/QALY in otherwise healthy adults below the per capita GDP in 2020(CNY 72,447).Even not considering the transmission dynamics model, the ICER of baloxavir was CNY 50,524.51/QALY in high risk adults, which is also below the per capita GDP in 2020. Sensitivity analysis shows the robustness of the results.

CONCLUSIONS: Compared to oseltamivir, baloxavir is very cost-effective intervention treating seasonal influenza in China and even a dominant alternative for high risk patients considering its potential value on transmission prevention.