Cost–effectiveness analysis of quadrivalent influenza vaccine in Spain

Abstract

Influenza has a major impact on healthcare systems and society, but can be prevented using vaccination. The World Health Organization (WHO) currently recommends that influenza vaccines should include at least two virus A and one virus B lineage (trivalent vaccine; TIV). A new quadrivalent vaccine (QIV), which includes an additional B virus strain, received regulatory approval and is now recommended by several countries. The present study estimates the cost-effectiveness of replacing TIVs with QIV for risk groups and elderly population in Spain. A static, lifetime, multi-cohort Markov model with a one-year cycle time was adapted to assess the costs and health outcomes associated with a switch from TIV to QIV. The model followed a cohort vaccinated each year according to health authority recommendations, for the duration of their lives. National epidemiological data allowed the determination of whether the B strain included in TIVs matched the circulating one. Societal perspective was considered, costs and outcomes were discounted at 3% and one-way and probabilistic sensitivity analyses were performed. Compared to TIVs, QIV reduced more influenza cases and influenza-related complications and deaths during periods of B-mismatch strains in the TIV. The incremental cost-effectiveness ratio (ICER) was 8,748€/quality-adjusted life year (QALY). One-way sensitivity analysis showed mismatch with the B lineage included in the TIV was the main driver for ICER. Probabilistic sensitivity analysis shows ICER below 30,000€/QALY in 96% of simulations. Replacing TIVs with QIV in Spain could improve influenza prevention by avoiding B virus mismatch and provide a cost-effective healthcare intervention.

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.…”

“…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].…”

“…population, for example, herd protection or potential age shifts regarding incidence peaks [40,41]. The other 11 studies used static models [20][21][22][25][26][27][28][32][33][34][35]. Three of these 11 studies used the same Markov model [25,28,33] developed by van Bellinghen et al [33], while 6 studies [20,21,26,27,32,34] followed and extended the approach that was explained in the online available spreadsheetbased model by Reed et al [42].…”

“…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.…”

“…A summary of the general study characteristics is given in [20,31], Spain [25], Finland [30], Australia [26], Germany [24], and Hong Kong [34,35]. One study analyzed the economic impact of QIV in 5 countries of the European Union (EU) and extrapolated this to all 27 EU countries [32].…”