A Novel Dynamic Model for Health Economic Analysis of Influenza Vaccination in the Elderly

Abstract

IntroductionNew vaccines are being developed to improve the efficacy of seasonal influenza immunization in elderly persons aged ≥65 years. These products require clinical and economic evaluation to aid policy decisions.MethodsTo address this need, a two-part model has been developed, which we have applied to examine the potential clinical and economic impact of vaccinating elderly persons with adjuvanted trivalent inactivated influenza vaccine (aTIV) relative to conventional trivalent (TIV) and quadrivalent (QIV) vaccines. We compared outcomes in the US population for (1) aTIV in persons aged ≥65 years and QIV in all other age cohorts; (2) QIV in all cohorts; (3) TIV in all cohorts. Low, average, and high intensity seasons with low, average, and high vaccine match scenarios were compared. Probabilistic sensitivity analysis was conducted within each discrete scenario to explore the impact of variation in model inputs on potential outcomes.ResultsAssuming current vaccination coverage rates in the US population with (a) 25% better efficacy of adjuvanted versus non-adjuvanted vaccine against any strain and (b) 35% better efficacy of non-adjuvanted vaccine against matched B versus mismatched B strains, use of aTIV in persons aged ≥65 years and QIV in persons <65 years could reduce influenza cases by 11,166–1,329,200, hospitalizations by 1365–43,674, and deaths by 421–11,320 versus use of QIV in all cohorts. These outcomes are reflected in a corresponding increase in quality-adjusted life-years (QALYs) of 3003–94,084. If the prevalence of mismatched influenza B was >54.5% of all circulating strains, use of QIV in all cohorts would offset the clinical benefits of aTIV. Elderly aTIV or QIV vaccination was associated with improved outcomes over non-adjuvanted TIV in many of the scenarios, particularly in low match seasons of any intensity. Total cost savings (including direct and indirect healthcare costs plus productivity impacts) with aTIV in the elderly versus QIV in the whole population ranged from $27 million (low intensity, low match) to $934 million (high intensity, high match). Univariate sensitivity analysis of relative vaccine prices in the average intensity, average match scenario indicated that aTIV could be marginally cost saving relative to QIV at the currently published Medicare price for influenza vaccines offering enhanced efficacy in the elderly. Elderly vaccination with aTIV was associated with a higher overall cost compared with TIV in only two scenarios (low intensity with average or high match); the incremental cost/QALY relative to TIV was $9980 in the average match scenario and $28,800 in the high match scenario.ConclusionsVaccination of persons aged ≥65 years with aTIV has the potential to provide clinical and economic benefit relative to QIV and TIV. The new model allows the assessment of various alternative strategies for available influenza vaccines.FundingNovartis Vaccines.Electronic supplementary materialThe online version of this article (doi:10.1007/s40121-015-0076-8) contains supplementary...

A systematic review of the health economic consequences of quadrivalent influenza vaccination

“…Of these 35 studies, 2 studies were excluded after screening titles and abstracts, and from 18 studies no full-text was available as these referred to conference abstracts only. As one additional study that met our inclusion criteria was identified outside the initial search, we ended up with 16 eligible studies [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. The flowchart of the study identification process is displayed in Figure 1.…”

“…One study comprised a main paper and a corrigendum [27,36]. Of these 16 studies, 2 did not primarily focus on the cost-effectiveness of QIV as compared with TIV, but on high-dose TIV [21] or adjuvanted TIV [29] as compared with TIV and QIV. However, as both studies reported detailed results of TIV and QIV, we included these studies in our review.…”

“…A total of 13 out of 16 studies were ranked as good, adhering to more than 17 out of 24 items on the CHEERs checklist [20][21][22][23][24][25][26][28][29][30][31]33,35], while 3 studies were assessed as moderate, adhering to less than 17 out of 24 points [27,32,34]. Arguments for the choice of time-horizon and model-type were most often not reported.…”

“…Out of the 16 studies, 13 were funded by manufacturers [20][21][22][23][24][25][26][28][29][30][31][32][33], 1 was funded by public sources [27], and 2 studies were conducted without reporting any specific funding [34,35]. A total of 13 studies performed a cost-utility analysis [20][21][22][23][24][25][28][29][30][31][33][34][35], expressing results as costs per QALY gained. The remaining three studies conducted cost-comparisons [26,27,32].…”

“…Five studies used a dynamic modeling approach [23,24,[29][30][31]. For three of these five studies, a more detailed description of the dynamic model was previously published [37][38][39].…”