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. 2016 Oct;64(10):2126-2131.
doi: 10.1111/jgs.14323. Epub 2016 Oct 6.

Cost-Effectiveness and Public Health Effect of Influenza Vaccine Strategies for U.S. Elderly Adults

Jonathan M Raviotta  1 , Kenneth J Smith  2 , Jay DePasse  3 , Shawn T Brown  3 , Eunha Shim  4 , Mary Patricia Nowalk  2 , Richard K Zimmerman  2
Affiliations

Cost-Effectiveness and Public Health Effect of Influenza Vaccine Strategies for U.S. Elderly Adults

Jonathan M Raviotta et al. J Am Geriatr Soc. 2016 Oct.

Abstract

Objectives: To compare the cost-effectiveness of four influenza vaccines available in the United States for persons aged 65 and older: trivalent inactivated influenza vaccine (IIV3), quadrivalent inactivated influenza vaccine (IIV4), a more-expensive high-dose IIV3, and a newly approved adjuvanted IIV3.

Design: Cost-effectiveness analysis using a Markov model and sensitivity analyses.

Setting: A hypothetical influenza vaccination season modeled according to possible U.S. influenza vaccination policies.

Participants: Hypothetical cohort of individuals aged 65 and older in the United States.

Measurements: Cost-effectiveness and public health benefits of available influenza vaccination strategies in U.S. elderly adults.

Results: IIV3 cost $3,690 per quality-adjusted life year (QALY) gained, IIV4 cost $20,939 more than IIV3 per QALY gained, and high-dose IIV3 cost $31,214 more per QALY than IIV4. The model projected 83,775 fewer influenza cases and 980 fewer deaths with high-dose IIV3 than with the next most-effective vaccine: IIV4. In a probabilistic sensitivity analysis, high-dose IIV3 was the favored strategy if willingness to pay is $25,000 or more per QALY gained. Adjuvanted IIV3 cost-effectiveness depends on its price and effectiveness (neither yet determined in the United States) but could be favored if its relative effectiveness is 15% greater than that of IIV3.

Conclusion: From economic and public health standpoints, high-dose IIV3 for adults aged 65 years and older is likely to be favored over the other vaccines, based on currently available data. The cost-effectiveness of adjuvanted IIV3 should be reviewed after its effectiveness has been compared with that of other vaccines and its U.S. price is established.

Keywords: cost effectiveness; high-dose IIV3; influenza vaccination.

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Conflict of interest statement

Checklist: Elements of Financial/Personal Conflicts J Raviotta K Smith J DePasse S Brown Yes No Yes No Yes No Yes No Employment or Affiliation X X X X Grants/Funds X X X X Honoraria X X X X Speaker Forum X X X X Consultant X X X X Stocks X X X X Royalties X X X X Expert Testimony X X X X Board Member X X X X Patents X X X X Personal Relationship X X X X Elements of Financial/Personal Conflicts E Shim MP Nowalk R Zimmerman Yes No Yes No Yes No Employment or Affiliation X X X Grants/Funds X X X Honoraria X X X Speaker Forum X X X Consultant X X X Stocks X X X Royalties X X X Expert Testimony X X X Board Member X X X Patents X X X Personal Relationship X X X *Authors can be listed by abbreviations of their names. For “yes” x mark(s): give brief explanation below: Dr. Zimmerman has active research grants from Sanofi Pasteur, Merck & Co., Inc., and Pfizer Inc. Mary Patricia Nowalk has received or currently receives grant funding from Pfizer, Inc., and Merck & Co., Inc. and in the past was a consultant to MedImmune, LLC. Jonathan Raviotta currently receives grant funding from Pfizer, Inc. and Merck & Co., Inc. All other authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1. Cost effectiveness acceptability curve
Plot of the results of a probabilistic sensitivity analysis. Each increment on the x axis of willingness-to-pay represents 5000 complete model iterations where the values for every variable are randomly selected from an appropriately parameterized distribution. The plotted values on the y axis represent the percentage of iterations where each strategy was cost-effective at the given willingness-to-pay. High-dose trivalent influenza vaccine strategy was favored if the willingness-to-pay was ≥$25,000/quality adjusted life year gained
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References

    1. Reed C, Kim IK, Singleton JA, Chaves SS, Flannery B, Finelli L, et al. Estimated influenza illnesses and hospitalizations averted by vaccination–United States, 2013–14 influenza season. MMWR Morb Mortal Wkly Rep. 2014;63(49):1151–4. - PMC - PubMed
    1. Simonsen L, Taylor RJ, Viboud C, Miller MA, Jackson LA. Mortality benefits of influenza vaccination in elderly people: an ongoing controversy. Lancet Infect Dis. 2007;7(10):658–66. - PubMed
    1. DiazGranados CA, Dunning AJ, Kimmel M, Kirby D, Treanor J, Collins A, et al. Efficacy of high-dose versus standard-dose influenza vaccine in older adults. N Engl J Med. 2014;371(7):635–45. - PubMed
    1. Chit A, Becker DL, DiazGranados CA, Maschio M, Yau E, Drummond M. Cost-effectiveness of high-dose versus standard-dose inactivated influenza vaccine in adults aged 65 years and older: an economic evaluation of data from a randomised controlled trial. Lancet Infect Dis. 2015;15(12):1459–66. - PubMed
    1. Fluad–an adjuvanted seasonal influenza vaccine for older adults. Med Lett Drugs Ther. 2016;58(1486):8. - PubMed

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