Cost-effectiveness of live attenuated influenza vaccine versus inactivated influenza vaccine among children aged 24–59 months in the United States

Luce, Bryan R.; Nichol, Kristin L.; Belshe, Robert B.; Frick, Kevin D.; Li, Su Xia; Boscoe, Audra; Rousculp, Matthew D.; Mahadevia, Parthiv J.

doi:10.1016/j.vaccine.2008.03.046

Cited by 57 publications

(61 citation statements)

References 44 publications

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“…From the parent’s perspective, this component is important when comparing the cost of immunizing a child in school or at a traditional medical practice setting. The dollar values for parents’ time [17–19] ($41.80 for two hours at the national median hourly wage regardless of a parent’s employment status) and transportation cost [20] ($6.32) were obtained from the literature. The combined value ($48.12) was discounted by 27.1% to $35.08, because our analysis of the Medical Expenditure Panel Survey (MEPS) [21] showed that 27.1% of children aged 7 to 12 years had at least one primary care visit during an influenza vaccination period between 10/1/2007 and 1/31/2008.…”

Section: Methodsmentioning

confidence: 99%

Cost effectiveness analysis of elementary school-located vaccination against influenza—Results from a randomized controlled trial

Yoo

Humiston

Szilâgyi

et al. 2013

Vaccine

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School-located vaccination against influenza (SLV-I) has been suggested to help meet the need for annual vaccination of large numbers of school-aged children with seasonal influenza vaccine. However, little is known about the cost and cost-effectiveness of SLV-I. We conducted a cost-analysis and a cost-effectiveness analysis based on a randomized controlled trial (RCT) of an SLV-I program implemented in Monroe County, New York during the 2009–2010 vaccination season. We hypothesized that SLV-I is more cost effective, or less-costly, compared to a conventional, office-located influenza vaccination delivery. First and second SLV-I clinics were offered in 21 intervention elementary schools (n=9,027 children) with standard of care (no SLV-I) in 11 control schools (n=4,534 children). The direct costs, to purchase and administer vaccines, were estimated from our RCT. The effectiveness measure, receipt of ≥1 dose of influenza vaccine, was 13.2 percentage points higher in SLV-I schools than control schools. The school costs ($9.16/dose in 2009 dollars) plus project costs ($23.00/dose) plus vendor costs excluding vaccine purchase ($19.89/dose) was higher in direct costs ($52.05/dose) than the previously reported mean/median cost [$38.23/$21.44 per dose] for providing influenza vaccination in pediatric practices. However SLV-I averted parent costs to visit medical practices ($35.08 per vaccine). Combining direct and averted costs through Monte Carlo Simulation, SLV-I costs were $19.26/dose in net costs, which is below practice-based influenza vaccination costs. The incremental cost-effectiveness ratio (ICER) was estimated to be $92.50 or $38.59 (also including averted parent costs). When additionally accounting for the costs averted by disease prevention (i.e., both reduced disease transmission to household members and reduced loss of productivity from caring for a sick child), the SLV-I model appears to be cost-saving to society, compared to “no vaccination”. Our findings support the expanded implementation of SLV-I, but also the need to focus on efficient delivery to reduce direct costs.

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Section: Methodsmentioning

confidence: 99%

Cost effectiveness analysis of elementary school-located vaccination against influenza—Results from a randomized controlled trial

Yoo

Humiston

Szilâgyi

et al. 2013

Vaccine

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“…The utility loss of each health status was estimated from findings of health-related quality of life studies. [20][21][22][23][24][25][26] The time-spent in outpatient care and hospitalization were the duration of illness and length of hospital stay, correspondingly. 15,16,27,28 The QALYs loss as a result of deaths occurred during the model year were calculated using life expectancy in Hong Kong and age-specific utility values, and the future loss of QALYs due to death were discounted by 3% per year.…”

Section: Clinical Inputsmentioning

confidence: 99%

Cost-effectiveness of quadrivalent influenza vaccine in Hong Kong – A decision analysis

You

Ming

Chan

2015

Human Vaccines & Immunotherapeutics

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Trivalent influenza vaccine (TIV) selects one of the 2 co-circulating influenza B lineages whereas quadrivalent influenza vaccine (QIV) includes both lineages. We examined potential cost-effectiveness of QIV versus TIV from perspectives of healthcare provider and society of Hong Kong. A decision tree was designed to simulate the outcomes of QIV vs. TIV in 6 age groups: 0-4 years, 5-9 years, 10-14 years, 15-64 years, 65-79 y and ≥80 years. Direct cost alone, direct and indirect costs, and quality-adjusted life-years (QALYs) loss due to TIV-unmatched influenza B infection were simulated for each study arm. Outcome measure was incremental cost per QALY (ICER). In base-case analysis, QIV was more effective than TIV in all-age population with additional direct cost per QALY (ICER-direct cost) and additional total cost per QALY (ICER-total cost) of USD 22,603 and USD 12,558, respectively. Age-stratified analysis showed that QIV was cost-effective in age groups 6 months to 9 y and ≥80 years from provider's perspective, and it was cost-effective in all age group except 15-64 y from societal perspective. Percentage of TIV-unmatched influenza B in circulation and additional vaccine cost of QIV were key influential factors. From perspectives of healthcare provider and society, QIV was the preferred option in 52.77% and 66.94% of 10,000 Monte Carlo simulations, respectively. QIV appears to be cost-effective in Hong Kong population, except for age group 15-64 years, from societal perspective. From healthcare provider's perspective, QIV seems to be cost-effective in very young (6 months-9 years) and older (≥80 years) age groups.

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“…13–15 Only one CEA compared LAIV with IIV among U.S. children; however, it only included children aged 24–59 months and did not account for herd immunity effects. 16 …”

Section: Introductionmentioning

confidence: 99%

Cost Effectiveness of Influenza Vaccine Choices in Children Aged 2–8 Years in the U.S.

Raviotta

DePasse

Brown

et al. 2016

American Journal of Preventive Medicine

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Introduction Prior evidence found live attenuated influenza vaccine (LAIV) more effective than inactivated influenza vaccine (IIV) in children aged 2–8 years, leading CDC in 2014 to prefer LAIV use in this group. However, since 2013, LAIV has not proven superior, leading CDC in 2015 to rescind their LAIV preference statement. Here, the cost effectiveness of preferred LAIV use compared with IIV in children aged 2–8 years is estimated. Methods A Markov model estimated vaccination strategy cost effectiveness in terms of cost per quality-adjusted life year gained. Base case assumptions were: equal vaccine uptake, IIV use when LAIV was not indicated (in 11.7% of the cohort), and no indirect vaccination effects. Sensitivity analyses included estimates of indirect effects from both equation- and agent-based models. Analyses were performed in 2014–2015. Results Using prior effectiveness data in children aged 2–8 years (LAIV=83%, IIV=64%), preferred LAIV use was less costly and more effective than IIV (dominant), with results sensitive only to LAIV and IIV effectiveness variation. Using 2014–2015 U.S. effectiveness data (LAIV=0%, IIV=15%), IIV was dominant. In two-way sensitivity analyses, LAIV use was cost saving over the entire range of IIV effectiveness (0%–81%) when absolute LAIV effectiveness was >7.1% higher than IIV, but never cost saving when absolute LAIV effectiveness was <3.5% higher than IIV. Conclusions Results support CDC’s decision to no longer prefer LAIV use and provide guidance on effectiveness differences between influenza vaccines that might lead to preferential LAIV recommendation for children aged 2–8 years.

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Cost-effectiveness of live attenuated influenza vaccine versus inactivated influenza vaccine among children aged 24–59 months in the United States

Cited by 57 publications

References 44 publications

Cost effectiveness analysis of elementary school-located vaccination against influenza—Results from a randomized controlled trial

Cost effectiveness analysis of elementary school-located vaccination against influenza—Results from a randomized controlled trial

Cost-effectiveness of quadrivalent influenza vaccine in Hong Kong – A decision analysis

Cost Effectiveness of Influenza Vaccine Choices in Children Aged 2–8 Years in the U.S.

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