Cost-Effectiveness of Antiviral Drugs to Prevent or Treat Influenza A, Influenza B, or Zoonotic Influenza

Key Messages

What Is the Issue?

• Influenza is a major public health concern, causing significant illness, death, economic challenges, and pandemic potential. This underscores the need for effective prevention (also known as prophylaxis), treatment, and pandemic preparedness strategies.
• Antiviral medications such as baloxavir marboxil, oseltamivir, peramivir, zanamivir are recommended for the treatment of influenza; however, their economic value remains unclear.

What Did We Do?

• We conducted a rapid review to identify and summarize evidence on the cost-effectiveness of antivirals for preventing and treating influenza A, influenza B, and zoonotic influenza, as well as the cost-effectiveness of antiviral stockpiling.
• We searched electronic databases and key online sources for economic evaluation studies published in English from January 1, 2019, to December 13, 2024. Additionally, we examined the cost-effectiveness of stockpiling from studies published from January 1, 2020, to April 4, 2025.
• One researcher screened citations, selected studies, and narratively summarized the study findings.

What Did We Find?

• We identified 9 economic evaluations: 8 examining the treatment of influenza and 1 examining both post-exposure prophylaxis and treatment.
• We did not identify any studies on the cost-effectiveness of antivirals for the prophylaxis or treatment of zoonotic influenza or any studies that evaluated the cost-effectiveness of stockpiling antiviral drugs.
• Economic studies suggest that certain antivirals may be cost-effective for treating influenza compared to standard of care, particularly in high-risk populations. However, it is unclear how cost-effective antivirals are for post-exposure prophylaxis, as there is limited evidence from just 1 study.

What Does It Mean?

• Economic evaluations suggest that oseltamivir or baloxavir marboxil are cost-effective treatments for influenza, particularly in high-risk populations.
• Baloxavir marboxil may be a valuable alternative in cases of oseltamivir resistance to ensure optimal resource allocation and long-term sustainability of antiviral treatments. However, its higher cost requires careful consideration.
• The generalizability of existing economic evaluations may be limited due to variability in influenza strains, health care systems, and cost structures that differ from Canada.