Cost-Effectiveness of Adjuvanted Versus Nonadjuvanted Influenza Vaccine in Adult Hemodialysis Patients

Abstract

Background Currently, over 340,000 individuals are receiving long-term hemodialysis (HD) therapy for end-stage renal disease and therefore are particularly vulnerable to influenza, prone to more severe influenza outcomes, and less likely to achieve seroprotection from standard influenza vaccines. Influenza vaccine adjuvants, chemical or biological compounds added to a vaccine to boost the elicited immunological response, may help overcome this problem. Study design Economic stochastic decision analytic simulation model. Setting & Participants United States adult HD population. Model, Perspective, & Timeframe The model simulated the decision to use either an adjuvanted or non-adjuvanted vaccine, assumed the societal perspective, and represented a single influenza season, or 1 year. Intervention Adjuvanted influenza vaccine at different adjuvant costs and efficacies. Sensitivity analyses explored the impact of varying the influenza clinical attack rate, influenza hospitalization rate, and influenza-related mortality. Outcomes Incremental cost-effectiveness ratio (ICER) of adjuvanted influenza vaccine (versus non-adjuvanted) with effectiveness measured in quality-adjusted life-years (QALYs). Results Adjuvanted influenza vaccine would be cost-effective (ICER<$50,000/QALY) at a $1 adjuvant cost (on top of the standard vaccine cost) when the adjuvant efficacy (in overcoming the difference between influenza vaccine response in HD patients and healthy adults) ≥60% and economically dominant (provides both cost savings and health benefits) when the $1 adjuvant's efficacy is 100%. A $2 adjuvant would be cost-effective should the adjuvant efficacy be 100%. Limitations All models are simplifications of real life and cannot possibly capture all possible factors and outcomes. Conclusions An adjuvanted influenza vaccine with adjuvant cost ≤$2 could be cost-effective strategy in a standard influenza season depending on the potency of the adjuvant.

A self-aggregating peptide: implications for the development of thermostable vaccine candidates

“…For this reason, in recent years new technologies have been developed to advance in the production of more efficient and safer vaccines [10,14,15]. Lowering the cost of vaccines is an essential step to facilitate massive vaccination especially in isolated areas where the cold-chain cannot be maintained easily [14,16]. This last point is especially important since the cold chain represents about 80% of the cost of vaccines [17,18].…”

Cost-Effectiveness of Increasing Influenza Vaccination Coverage in Adults with Type 2 Diabetes in Turkey

“…Relatively few studies have been performed to assess cost-effectiveness of influenza vaccination in patients with underlying conditions, especially those with diabetes. Influenza vaccination has been shown to be cost-effective in patients with other underlying conditions, such as chronic obstructive pulmonary disease [ 53 ], coronary heart disease [ 54 ], cancer [ 55 ], hemodialysis [ 56 ], and human immunodeficiency virus infection [ 57 ]. Although the literature focusing on patients with diabetes is limited, influenza vaccination has been shown to be cost-effective in the US [ 58 ].…”

Prevention of influenza in healthy children

“…Since younger children (especially those less than 2 years old) may not have fully developed immune systems, the use of adjuvanted vaccines has been under study. Adjuvants are chemical compounds added to the vaccine to boost the host's immune response to the vaccine antigen, enhancing protection [10][11][12]. Only the TIV is approved for children younger than 2 years, and a 2008 Cochrane review, using data from the only randomized controlled trial (RCT) in this age group, could not confirm its enhanced efficacy [13].…”

“…The benefits of a multiyear vaccine are derived from reducing the number of immunizations necessary, eliminating the need for annual compliance with vaccination and improving the vaccine to match the circulating strain each year. Administering a vaccine that could protect children (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) year olds) for 5 years instead of annual immunization could save US$15 million-billion over their lifetimes. Increasing the duration of protection would of course increase these savings; protection for 10 years could increase these savings to US$5-9 billion.…”