Cost-effectiveness of an influenza vaccination program offering intramuscular and intradermal vaccines versus intramuscular vaccine alone for elderly |
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| Affiliation: | 1. Department of Health Management and Policy, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States;2. Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States;3. Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States;1. Immunization Service Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, USA;2. Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, USA;3. Battelle Memorial Institute, USA;1. Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium;2. Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Hasselt University, Hasselt, Belgium;3. Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium;4. School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia;1. Sanofi Pasteur, Swiftwater, PA, USA;2. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada;3. Optum, Burlington, ON, Canada;4. inVentiv Health Clinical, Burlington, ON, Canada;5. University of York, York, UK;1. Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi 710061, China;2. Department of Obstetrics, Northwest Women''s and Children''s Hospital, Xi''an, Shaanxi 710061, China;3. Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia;4. Central Clinical School, Faculty of Medicine, Monash University, Melbourne, Australia;5. School of Public Health and Preventive Medicine, Faculty of Medicine, Monash University, Melbourne, Australia |
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| Abstract: | BackgroundIntradermal (ID) injection is an alternative route for influenza vaccine administration in elderly with potential improvement of vaccine coverage. This study aimed to investigate the cost-effectiveness of an influenza vaccination program offering ID vaccine to elderly who had declined intramuscular (IM) vaccine from the perspective of Hong Kong public healthcare provider.MethodsA decision analytic model was used to simulate outcomes of two programs: IM vaccine alone (IM program), and IM or ID vaccine (IM/ID program) in a hypothetic cohort of elderly aged 65 years. Outcome measures included influenza-related direct medical cost, infection rate, mortality rate, quality-adjusted life years (QALYs) loss, and incremental cost per QALY saved (ICER). Model inputs were derived from literature. Sensitivity analyses evaluated the impact of uncertainty of model variables.ResultsIn base-case analysis, the IM/ID program was more costly (USD52.82 versus USD47.59 per individual to whom vaccine was offered) with lower influenza infection rate (8.71% versus 9.65%), mortality rate (0.021% versus 0.024%) and QALYs loss (0.00336 versus 0.00372) than the IM program. ICER of IM/ID program was USD14,528 per QALY saved. One-way sensitivity analysis found ICER of IM/ID program to exceed willingness-to-pay threshold (USD39,933) when probability of influenza infection in unvaccinated elderly decreased from 10.6% to 5.4%. In 10,000 Monte Carlo simulations of elderly populations of Hong Kong, the IM/ID program was the preferred option in 94.7% of time.ConclusionsAn influenza vaccination program offering ID vaccine to elderly who had declined IM vaccine appears to be a highly cost-effective option. |
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| Keywords: | Seasonal influenza vaccine Microneedle Intradermal injection Intramuscular injection Elderly Cost-effectiveness |
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