A real-world study evaluating the relative vaccine effectiveness of a cell-based quadrivalent influenza vaccine compared to egg-based quadrivalent influenza vaccine in the US during the 2017-18 influenza season

Victoria Divino*, Girishanthy Krishnarajah, Stephen Pelton, Joaquin Mould-Quevedo, Vamshi Ruthwik Anupindi, Mitch DeKoven, Maarten J. Postma

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Background: Cell-based influenza vaccine manufacturing reduces egg adaptations that can decrease vaccine effectiveness. We evaluated the relative vaccine effectiveness (rVE) of cell-based quadrivalent influenza vaccine (QIVc) compared to standard-dose egg-based quadrivalent influenza vaccines (QIVe-SD) against influenza-related and serious respiratory events among subjects 4-64 years of age during the 2017-18 influenza season.

Methods: A retrospective cohort analysis was conducted using administrative claims data in the US (IQVIA PharMetrics Plus (R) database). Subjects vaccinated with QIVc or QIVe-SD from 8/2017-1/2018 were identified (date of vaccination termed the index date). Influenza-related hospitalizations/ER visits, allcause hospitalizations and serious respiratory hospitalizations/ER visits were assessed postvaccination. Inverse probability of treatment weighting (IPTW) and Poisson regression were used to evaluate the adjusted rVE of QIVc compared to QIVe-SD. In a subgroup analysis, rVE was assessed for several subgroups of interest (4-17, 18-64 and 50-64 years, and subjects with >= 1 high-risk condition). In a secondary economic analysis, annualized all-cause costs over the follow-up were compared using propensity score matching (PSM) and generalized estimating equation (GEE) models.

Results: The study sample comprised 555,538 QIVc recipients and 2,528,524 QIVe-SD recipients. Prior to adjustment, QIVc subjects were older and had higher total costs in the 6-months pre-index. Following IPTW-adjustment and Poisson regression, QIVc was more effective in reducing influenza-related hospitalizations/ER visits, all-cause hospitalizations, and hospitalizations/ER visits related to asthma/COPD/bronchial events and other respiratory events compared to QIVe-SD. Similar trends were generally observed in the subgroup analysis. Following PSM adjustment and GEE regression, QIVe-SD was associated with significantly higher annualized all-cause total costs compared to QIVc, driven by higher costs for outpatient medical services and inpatient hospitalizations.

Conclusions: After adjustment for confounders and selection bias, QIVc reduced influenza-related hospitalizations/ER visits, all-cause hospitalizations, and serious respiratory hospitalizations/ER visits compared to QIVe-SD. QIVc was associated with significantly lower all-cause total costs. (C) 2020 The Authors. Published by Elsevier Ltd.

Original languageEnglish
Pages (from-to)6334-6343
Number of pages10
Issue number40
Publication statusPublished - 11-Sept-2020


  • Influenza
  • Influenza vaccine
  • Relative vaccine effectiveness
  • Retrospective studies
  • Observational studies
  • Cell-based influenza vaccine

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