Cost-effectiveness and public health impact of alternative influenza vaccination strategies in high-risk adults |
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Institution: | 1. Deakin Health Economics, Deakin University, 221 Burwood Highway, Burwood, VIC 3025, Australia;2. SunSmart Program, Cancer Council Victoria, WHO Collaborative Centre for UV Radiation, 615 St Kilda Road, Melbourne, VIC 3004, Australia;3. Prevention Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC 3004, Australia |
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Abstract: | PurposeHigh-dose trivalent inactivated influenza vaccine (HD-IIV3) or recombinant trivalent influenza vaccine (RIV) may increase influenza vaccine effectiveness (VE) in adults with conditions that place them at high risk for influenza complications. This analysis models the public health impact and cost-effectiveness (CE) of these vaccines for 50–64 year-olds.MethodsMarkov model CE analysis compared 5 strategies in 50–64 year-olds: no vaccination; only standard-dose IIV3 offered (SD-IIV3 only), only quadrivalent influenza vaccine offered (SD-IIV4 only); high-risk patients receiving HD-IIV3, others receiving SD-IIV3 (HD-IIV3 & SD-IIV3); and high-risk patients receiving HD-IIV3, others receiving SD-IIV4 (HD-IIV3 & SD-IIV4). In a secondary analysis, RIV replaced HD-IIV3. Parameters were obtained from U.S. databases, the medical literature and extrapolations from VE estimates. Effectiveness was measured as 3%/year discounted quality adjusted life year (QALY) losses avoided.ResultsThe least expensive strategy was SD-IIV3 only, with total costs of $99.84/person. The SD-IIV4 only strategy cost an additional $0.91/person, or $37,700/QALY gained. The HD-IIV3 & SD-IIV4 strategy cost $1.06 more than SD-IIV4 only, or $71,500/QALY gained. No vaccination and HD-IIV3 & SD-IIV3 strategies were dominated. Results were sensitive to influenza incidence, vaccine cost, standard-dose VE in the entire population and high-dose VE in high-risk patients. The CE of RIV for high-risk patients was dependent on as yet unknown parameter values.ConclusionsBased on available data, using high-dose influenza vaccine or RIV in middle-aged, high-risk patients may be an economically favorable vaccination strategy with public health benefits. Clinical trials of these vaccines in this population may be warranted. |
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Keywords: | High dose influenza vaccine Cost-effectiveness analysis Influenza vaccination policy SD-IIV3"} {"#name":"keyword" "$":{"id":"k0025"} "$$":[{"#name":"text" "_":"standard-dose trivalent inactivated influenza vaccine HD-IIV3"} {"#name":"keyword" "$":{"id":"k0035"} "$$":[{"#name":"text" "_":"high-dose trivalent inactivated influenza vaccine RIV"} {"#name":"keyword" "$":{"id":"k0045"} "$$":[{"#name":"text" "_":"recombinant trivalent influenza vaccine IDA"} {"#name":"keyword" "$":{"id":"k0055"} "$$":[{"#name":"text" "_":"Influenza Decision Analysis SD-IIV4"} {"#name":"keyword" "$":{"id":"k0065"} "$$":[{"#name":"text" "_":"standard-dose quadrivalent influenza vaccine QALY"} {"#name":"keyword" "$":{"id":"k0075"} "$$":[{"#name":"text" "_":"Quality-adjusted life year |
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