BackgroundTrivalent influenza vaccines encompass one influenza B lineage; however, predictions have been unreliable on which of two antigenically distinct circulating lineages will dominate. Quadrivalent seasonal influenza vaccines contain strains from both lineages. This analysis assesses the cost effectiveness of switching from trivalent inactivated influenza vaccination (TIV) in Finland to quadrivalent vaccination, using inactivated (QIV) or live-attenuated (Q-LAIV) vaccines.MethodsA transmission model simulated the dynamics of influenza infection while accounting for indirect (herd) protection. Prior distributions for key transmission parameters were repeatedly sampled and simulations that fitted the available information on influenza in Finland were recorded. The resulting posterior parameter distributions were used in a probabilistic sensitivity analysis in which economic parameters were sampled, simultaneously encompassing uncertainty in the transmission and economic parameters. The cost effectiveness of a range of trivalent and quadrivalent vaccine policies over a 20-year time horizon was assessed from both a societal and payer perspective in 2014 Euros.ResultsThe simulated temporal incidence pattern of symptomatic infections corresponded well with case surveillance data. A switch from the current TIV to Q-LAIV in children (2 to <18 years) and to QIV in other ages was estimated to annually avert approximately 76,100 symptomatic infections (95 % range 36,700–146,700), 11,500 primary care consultations (6100–20,000), 540 hospitalisations (240–1180), and 72 deaths (32–160), and was cost-saving relative to TIV (€374 million averted [€161–€752], in 2014 Euros, discounted at 3 %). This scenario had the highest probability of being the most cost-effective scenario considered.ConclusionsThis analysis demonstrates that quadrivalent vaccination is expected to be highly cost effective, reducing the burden of influenza-related disease.Electronic supplementary materialThe online version of this article (doi:10.1007/s40273-016-0430-z) contains supplementary material, which is available to authorized users.

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This study compared the economic value of pediatric immunisation programmes for influenza to those for rotavirus (RV), meningococcal disease (MD), pneumococcal disease (PD), human papillomavirus (HPV), hepatitis B (Hep B), and varicella reported in recent (2000 onwards) cost-effectiveness (CE) studies identified in a systematic review of PubMed, health technology, and vaccination databases. The systematic review yielded 51 economic evaluation studies of pediatric immunisation — 10 (20%) for influenza and 41 (80%) for the other selected diseases. The quality of the eligible articles was assessed using Drummond's checklist. Although inherent challenges and limitations exist when comparing economic evaluations of immunisation programmes, an overall comparison of the included studies demonstrated cost-effectiveness/cost saving for influenza from a European-Union-Five (EU5) and United States (US) perspective; point estimates for cost/quality-adjusted life-years (QALY) from dominance (cost-saving with more effect) to ≤45,444 were reported. The economic value of influenza programmes was comparable to the other vaccines of interest, with cost/QALY in general considerably lower than RV, Hep B, MD and PD. Independent of the perspective and type of analysis, the economic impact of a pediatric influenza immunisation program was influenced by vaccine efficacy, immunisation coverage, costs, and most significantly by herd immunity. This review suggests that pediatric influenza immunisation may offer a cost effective strategy when compared with HPV and varicella and possibly more value compared with other childhood vaccines (RV, Hep B, MD and PD).

BackgroundInfluenza poses a significant burden on healthcare systems and society, with under-recognition in the paediatric population. Existing vaccination policies (largely) target the elderly and other risk groups where complications may arise.ObjectiveThe goal of this study was to evaluate the cost-effectiveness of annual paediatric vaccination (in 2–17-year-olds) with live attenuated influenza vaccination (LAIV), as well as the protective effect on the wider population in England and Wales (base). The study aimed to demonstrate broad applications of the model in countries where epidemiological and transmission data is limited and that have sophisticated vaccination policies (Brazil, Spain, and Taiwan).MethodsThe direct and indirect impact of LAIV in the paediatric cohort was simulated using an age-stratified dynamic transmission model over a 5-year time horizon of daily cycles and applying discounting of 3.5% in the base case. Pre-existing immunity structure was based on a 1-year model run. Sensitivity analyses were conducted.ResultsIn the base case for England and Wales, the annual paediatric strategy with LAIV was associated with improvements in influenza-related events and quality-adjusted life years (QALYs) lost, yielding an incremental cost per QALY of £6,208. The model was robust to change in the key input parameters. The probabilistic analysis demonstrated LAIV to be cost effective in more than 99% of iterations, assuming a willingness-to-pay threshold of £30,000. Incremental costs per QALY for Brazil were £2,817, and for the cases of Spain and Taiwan the proposed strategy was dominant over the current practice.ConclusionIn addition to existing policies, annual paediatric vaccination using LAIV provides a cost-effective strategy that offers direct and indirect protection in the wider community. Paediatric vaccination strategies using LAIV demonstrated clinical and economic benefits over alternative (current vaccination) strategies in England and Wales as well as Brazil, Spain, and Taiwan.

studies, respectively, was conducted. Methods: A Bayesian ITC was performed on efficacy and safety on the non-gBRCA data from NOVA (niraparib) and gBRCA wild type data from S19 (olaparib). Efficacy analyses compared investigator (INV) and independent review committee (IRC) assessed PFS hazard ratios (HR) and TFST HR. Safety analyses included odds ratios (OR) of any grade ≥ 3 adverse event (AE), AEs leading to dose interruption, reduction, and discontinuation. Results: HRs comparing olaparib and niraparib were 0.94 (95% credible interval 0.54-1.65) for investigator-assessed PFS, and 1.25 (0.67-2.30) for IRC PFS. TFST HR was 0.78 (0.47-1.30). No significant difference in efficacy between PARPi was observed. The corresponding ORs for AE were 0.34 (0.13-0.90), 0.54 (0.16-2.06), 0.16 (0.01-2.18) and 0.21 (0.04-1.21) for any grade ≥ 3 AE, and AE leading to dose interruption, discontinuation, and reduction, respectively. There was a significant reduction in the odds of any grade ≥ 3 AE. No significant difference in AE leading to dose interruption, reduction, and discontinuation. ConClusions: ITC shows no significant difference in efficacy between olaparib capsules and niraparib tablets as maintenance therapy in patients with non-gBRCAm PSROC following response to chemotherapy. Olaparib shows significantly reduced odds compared with niraparib for any grade ≥ 3 AE. No significant difference was observed in AEs leading to modification in drug administration.

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