Background: Thrombopoietin receptor agonists—romiplostim, eltrombopag and avatrombopag—are commonly used as second-line treatments for immune thrombocytopenia (ITP). Methods: A Markov model was developed to estimate the cost effectiveness of the three TPO-RAs in adults with insufficient response to previous treatment from the perspective of the UK National Health Service (NHS). The model considered the effects of bleeding events, concomitant ITP medications, rescue therapies and treatment related adverse events over a lifetime horizon. Model inputs for effectiveness were based on a network meta-analysis and other published literature on ITP management. Other model inputs included costs (e.g., drug acquisition and administration) and healthcare resource utilisation. Results: Avatrombopag was associated with higher quality-adjusted life-years (QALYs) (10.979) than romiplostim (10.628) and eltrombopag (10.085), producing incremental QALYs of −0.351 and −0.894, respectively. Avatrombopag was associated with lower total costs (GBP £319,334) compared with romiplostim (GBP 406,361 [cost saving of GBP 87,027]) and higher total costs compared with eltrombopag (GBP 313,987 [incremental cost of GBP 5347]). Avatrombopag therefore dominated romiplostim (more effective and less expensive) and was cost-effective versus eltrombopag (incremental cost-effectiveness ratio of GBP 5982 per QALY). Conclusions: Avatrombopag is a cost-effective treatment compared with romiplostim and eltrombopag for the second-line treatment of adults with ITP from the perspective of the UK NHS.

Introduction Influenza is a highly transmissible respiratory viral infection, with a risk of severe complications and excess respiratory mortality. Clinical trial data showed that baloxavir was more effective than oseltamivir for reducing duration of virus shedding, which is a key predictor of transmission. Consideration of the effect of treatments on transmission rates is important to ensure that the value of treatments is captured. This study assessed the cost-effectiveness of different treatment strategies with baloxavir and oseltamivir, considering their impact on influenza transmission. Methods The analysis used two models: a dynamic transmission model to estimate influenza incidence, with outputs incorporated in a static population-level decision tree model, in order to evaluate the clinical outcomes and cost-effectiveness of treatment strategies with different shares of baloxavir and oseltamivir from the healthcare payer’s perspective in Japan. Clinical data were sourced from phase 3 trials, and cost inputs were informed by the Ministry of Health, Labour and Welfare, as well as JammNet. Sensitivity and scenario analyses were also conducted. Results Increasing the use of baloxavir in adults from 40% to 50% reduces the number of influenza cases by 17%, hospitalizations by 18%, and deaths by 23%, with cost savings of JPY (Japanese yen) 16,280 million and 10,486 quality-adjusted life years (QALYs) gained, in the total population in Japan. Across all risk and age subgroups, increasing the share of baloxavir was cost-saving and more effective, and, therefore, was considered dominant, which was also confirmed by the sensitivity analysis. Conclusion Treatment of influenza with baloxavir is anticipated to offer value for money within Japan’s healthcare system, delivering significant clinical benefits both for the general population and for all age and risk groups. Accounting for the treatment’s impact on influenza transmission adds another dimension of value and further reinforces the evidence supporting the growing use of baloxavir in Japan.

Introduction Invasive meningococcal disease (IMD) caused by meningococcal serogroup B (MenB) is a rare but serious illness with potentially life-threatening outcomes, particularly in infants. In Brazil, IMD is endemic, with the highest incidence in infants and most cases being due to MenB. The four-component MenB vaccine (4CMenB), with potential cross-protection against other meningococcal serogroups, is approved in Brazil for active immunization of individuals aged 2 months to 50 years. This modeling study assessed the public health impact on all age groups in Brazil of introducing routine vaccination with the 4CMenB vaccine in infants aged < 1 year. Methods A static multigenerational multicohort model was developed using a discrete-time Markov approach over a 100-year time horizon. The model incorporates vaccine effectiveness, coverage, and waning rates to estimate the decrease in IMD incidence under the vaccination strategy (2 + 1 schedule at ages 3, 5, and 12 months) evaluated vs. no vaccination. Annual incidence rates of IMD by age group and serogroup between 2007 and 2023, excluding the COVID-19 pandemic period, were retrieved and adjusted for underreporting. Annual IMD-related deaths were calculated from age-specific case fatality rates. Results Assuming 69% cross-protection against serogroup W (MenW), the 4CMenB vaccination of infants would avert 63,038 (− 21%) IMD cases caused by MenB and MenW, and 11,301 (− 20%) deaths in all age groups. The model predicted a reduction of 21,408 (− 43%) MenB cases and 3335 (− 43%) deaths due to MenB in the < 1-year age group. Conclusion This modeling study highlights the considerable public health impact of introducing the 4CMenB vaccine for infants as part of Brazil’s routine vaccination schedule. By reducing IMD morbidity and mortality, routine 4CMenB immunization has the potential to substantially decrease the disease burden, improve long-term health outcomes, and reinforce the potential impact of preventive measures within the national immunization program. Graphical Abstract available for this article. Graphical Abstract

Background/Objectives: Respiratory syncytial virus (RSV) is a leading cause of severe respiratory disease in older adults. Despite growing recognition of RSV as a public health concern, vaccination options remain limited. This study assessed the potential long-term public health impact of extended mRNA-1345 RSV vaccination campaigns. Methods: A dynamic transmission model, stratified by age, was developed to evaluate the epidemiological and clinical impact of RSV vaccination in the UK over a 20-year time horizon. Eight vaccination strategies were assessed: two reflecting the JCVI recommendation for the 2024–2025 season and its recent extension, and six extended strategies considering broader eligible age groups, higher coverage, and/or revaccination every 2 or 3 years. Two exploratory analyses and extensive model validation versus reported data were also conducted. Results: Strategies combining broader age eligibility (≥60 years), higher coverage (80%), and 2-year revaccination achieved the greatest impact, preventing 310,000 hospitalisations over 20 years in the total UK population. Exploratory analyses showed that the expected public health impact might exceed the estimates presented in this analysis, if an alternative vaccine efficacy profile or the projected demographic shift would be confirmed. Conclusions: Extended RSV vaccination strategies including broader age eligibility and routine revaccination could offer substantial public health benefits in the UK. Targeting adults aged ≥60 years is expected to be particularly efficient in achieving a sustainable reduction in RSV burden. These findings could provide valuable support for national policy discussions on optimising RSV vaccination strategies in older adults, particularly regarding target age groups, revaccination schedules, and long-term programme planning.