Is influenza vaccination cost effective for healthy people between ages 65 and 74 years?A randomised controlled trial

Abstract

The aim of this study was to determine the cost effectiveness of influenza vaccination for healthy people aged 65-74 years living in the UK. People without risk factors for influenza (chronic heart, lung or renal disease, diabetic, immunosuppressed or those living in an institution) were identified from 20 general practitioner (GP) practices in Liverpool in September 1999. 729/5875 (12.4%) eligible individuals were recruited and randomised to receive either influenza vaccine or placebo (ratio 3:1), with all participants receiving 23-valent-pneumococcal polysaccharide vaccine unless already administered. The primary analysis was the frequency of influenza as recorded by a GP diagnosis of pneumonia or influenza like illness. In 2000, the UK vaccination policy was changed with influenza vaccine becoming available for all people aged 65 years and over irrespective of risk. As a consequence of this policy change, the study had to be fundamentally restructured and only results obtained over a one rather than the originally planned two-year randomised controlled trial framework were used. Results from 1999/2000 demonstrated no significant difference between groups for the primary outcome (relative risk 0.8, 95% CI 0.16-4.1). In addition, there were no deaths or hospitalisations for influenza associated respiratory illness in either group. The subsequent analysis, using both national and local sources of evidence, estimated the following cost effectiveness indicators: (1) incremental NHS cost per GP consultation avoided = 2000 pound sterling; (2) incremental NHS cost per hospital admission avoided = 61,000 pound sterling; (3) incremental NHS cost per death avoided = 1,900,000 pound sterling and (4) incremental NHS cost per QALY gained = 304,000 pound sterling. The analysis suggested that influenza vaccination in this population would not be cost effective.

The Relationship between Influenza Vaccination and Outpatient Visits for Upper Respiratory Infection by the Elderly in Taiwan

“…On the other hand, studies in the United States have shown the cost-effectiveness or cost-benefits of the influenza vaccine for people with different levels of health risk [3,8,10,11,20,21]. Cost-benefit and cost-effectiveness studies from other countries, including Canada [22], England and Wales, France, Germany [23], The Netherlands [24], New Zealand [25], and some local areas in Taiwan [26], also suggest that vaccinating the elderly is cost-effective and frequently cost saving, although a few have not [27,28].…”

Recommended immunization schedules for adults: Clinical practice guidelines by the Escmid Vaccine Study Group (EVASG), European Geriatric Medicine Society (EUGMS) and the World Association for Infectious Diseases and Immunological Disorders (WAidid)

“…60,61 The efficacy was found in specific elderly populations (i.e., older patients suffering from frailty, institutionalized elderly subjects, diabetes, chronic heart and chronic pulmonary disease, patients' undergoing haemodialysis and nursing home residents). 62,63 A recent Cochrane review showed the numerous biases of cohort studies that embellished the efficacy of vaccines, with the conclusion that new RCTs were needed.…”

Correlation between prescribing quality and pharmaceutical costs in English primary care: national cross-sectional analysis

“…The prescribing that fell within scope of the QOF was measured in the current study, but other studies have shown that such prescribing is only cost-effective in certain circumstances. As an example: clopidogrel was not cost-effective when compared with aspirin in patients with myocardial infarction; 15 aspirin may have no place in primary prevention; 16 guidance from the National Institute for Health and Clinical Excellence does not recommend beta blockers for anxiety because of evidence for lack of efficacy; 17 the British National Formulary does not recommend clonidine for migraine because of its side-effect profile; 18 influenza vaccination is not costeffective in patients who are healthy; 19 and statins are only cost-effective in primary prevention when used for high-risk patients 20 and those who are low risk may get no benefit at all. 21 Assuming that there is an appropriate rate of prescribing of QOF drugs outside of QOF indications by each practice, this should not alter the slope of the cost-quality relationship.…”