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Chi CY, Cheng MF, Ko K, Mould JF, Chen CJ, Huang YC, Lee PI. Cost-effectiveness analysis of cell-based versus egg-based quadrivalent influenza vaccines in the pediatric population in Taiwan. J Med Virol 2024; 96:e29279. [PMID: 38196182 DOI: 10.1002/jmv.29279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 11/03/2023] [Accepted: 11/19/2023] [Indexed: 01/11/2024]
Abstract
Cell-based influenza vaccines avoid egg-adaptive mutations, potentially improving vaccine effectiveness. We assessed the one-season cost-effectiveness of cell-based quadrivalent influenza vaccine (QIVc) against that of egg-derived quadrivalent influenza vaccines (QIVe) in children (6 months to 17 years of age) from payer and societal perspectives in Taiwan using an age-stratified static model. Base case and high egg adaptation scenarios were assessed. Deterministic and probabilistic sensitivity analyses were performed. The incremental cost-effectiveness ratio (ICER) threshold in Taiwan was assumed to be USD 99 177/quality-adjusted life year (QALY). Compared to QIVe, QIVc would prevent 15 665 influenza cases, 2244 complicated cases, and 259 hospitalizations per year. The base case ICER was USD 68 298/QALY and USD 40 085/QALY from the payer and societal perspective, respectively. In the high egg adaptation scenario, the ICER was USD 45 782/QALY from the payer's perspective and USD 17 489/QALY from the societal perspective. Deterministic sensitivity analyses indicated that infection incidence rate, vaccination coverage, and prevalence of the A/H3N2 strain were the main drivers of ICER. In conclusion, switching the immunization strategy from QIVe to QIVc is predicted to reduce the influenza-associated disease burden and be cost-effective for the pediatric population in Taiwan. The potential benefits of QIVc would be even higher during influenza seasons with high levels of egg adaptation.
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Affiliation(s)
- Chia-Yu Chi
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan
| | - Ming-Fang Cheng
- Department of Paediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Karam Ko
- Medical Affairs, Seqirus Korea Ltd., Seoul, Korea
| | - Joaquin F Mould
- Global Medical Affairs, CSL Seqirus USA Inc., Summit, New Jersey, USA
| | - Chih-Jung Chen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yhu-Chering Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ping-Ing Lee
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Gharpure R, Chard AN, Cabrera Escobar M, Zhou W, Valleau MM, Yau TS, Bresee JS, Azziz-Baumgartner E, Pallas SW, Lafond KE. Costs and cost-effectiveness of influenza illness and vaccination in low- and middle-income countries: A systematic review from 2012 to 2022. PLoS Med 2024; 21:e1004333. [PMID: 38181066 PMCID: PMC10802964 DOI: 10.1371/journal.pmed.1004333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 01/22/2024] [Accepted: 12/13/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Historically, lack of data on cost-effectiveness of influenza vaccination has been identified as a barrier to vaccine use in low- and middle-income countries. We conducted a systematic review of economic evaluations describing (1) costs of influenza illness; (2) costs of influenza vaccination programs; and (3) vaccination cost-effectiveness from low- and middle-income countries to assess if gaps persist that could hinder global implementation of influenza vaccination programs. METHODS AND FINDINGS We performed a systematic search in Medline, Embase, Cochrane Library, CINAHL, and Scopus in January 2022 and October 2023 using a combination of the following key words: "influenza" AND "cost" OR "economic." The search included studies with publication years 2012 through 2022. Studies were eligible if they (1) presented original, peer-reviewed findings on cost of illness, cost of vaccination program, or cost-effectiveness of vaccination for seasonal influenza; and (2) included data for at least 1 low- or middle-income country. We abstracted general study characteristics and data specific to each of the 3 study types. Of 54 included studies, 26 presented data on cost-effectiveness, 24 on cost-of-illness, and 5 on program costs. Represented countries were classified as upper-middle income (UMIC; n = 12), lower-middle income (LMIC; n = 7), and low-income (LIC; n = 3). The most evaluated target groups were children (n = 26 studies), older adults (n = 17), and persons with chronic medical conditions (n = 12); fewer studies evaluated pregnant persons (n = 9), healthcare workers (n = 5), and persons in congregate living settings (n = 1). Costs-of-illness were generally higher in UMICs than in LMICs/LICs; however, the highest national economic burden, as a percent of gross domestic product and national health expenditure, was reported from an LIC. Among studies that evaluated the cost-effectiveness of influenza vaccine introduction, most (88%) interpreted at least 1 scenario per target group as either cost-effective or cost-saving, based on thresholds designated in the study. Key limitations of this work included (1) heterogeneity across included studies; (2) restrictiveness of the inclusion criteria used; and (3) potential for missed influenza burden from use of sentinel surveillance systems. CONCLUSIONS The 54 studies identified in this review suggest an increased momentum to generate economic evidence about influenza illness and vaccination from low- and middle-income countries during 2012 to 2022. However, given that we observed substantial heterogeneity, continued evaluation of the economic burden of influenza illness and costs/cost-effectiveness of influenza vaccination, particularly in LICs and among underrepresented target groups (e.g., healthcare workers and pregnant persons), is needed. Use of standardized methodology could facilitate pooling across settings and knowledge sharing to strengthen global influenza vaccination programs.
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Affiliation(s)
- Radhika Gharpure
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anna N. Chard
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Weigong Zhou
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Molly M. Valleau
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tat S. Yau
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Joseph S. Bresee
- Task Force for Global Health, Atlanta, Georgia, United States of America
| | | | - Sarah W. Pallas
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kathryn E. Lafond
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Rolfes MA, Olsen SJ, Kittikraisak W, Suntarattiwong P, Klungthong C, Ellison D, Mott JA, Chotpitayasunondh T. Influenza-Associated Medical Visits Prevented by Influenza Vaccination in Young Children in Thailand, 2012-2014. J Pediatric Infect Dis Soc 2021; 10:349-351. [PMID: 32706366 PMCID: PMC10776449 DOI: 10.1093/jpids/piaa076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/24/2020] [Indexed: 11/12/2022]
Abstract
Despite recommendations, few children aged 6-35 months in Thailand receive seasonal influenza vaccination. Using previously estimated incidence and vaccine effectiveness data from the period 2012-2014, we estimate that up to 121 000 medical visits could be prevented each year with 50% coverage and expanded recommendations to children aged <5 years.
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Affiliation(s)
- Melissa A. Rolfes
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sonja J. Olsen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wanitchaya Kittikraisak
- Influenza Program, Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Piyarat Suntarattiwong
- Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand
| | | | - Damon Ellison
- US Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Joshua A. Mott
- Influenza Program, Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Tawee Chotpitayasunondh
- Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand
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Kiertiburanakul S, Phongsamart W, Tantawichien T, Manosuthi W, Kulchaitanaroaj P. Economic Burden of Influenza in Thailand: A Systematic Review. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 57:46958020982925. [PMID: 33355022 PMCID: PMC7873922 DOI: 10.1177/0046958020982925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Thailand has a high incidence and high mortality rates of influenza. This study
summarizes the evidence on economic burden or costs of influenza subsequent to
the occurrence of influenza illness in the Thai population by specific
characteristics such as population demographics, health conditions, healthcare
facilities, and/or cost types from published literature. A systematic search was
conducted in six electronic databases. All costs were extracted and adjusted to
2018 US dollar value. Out of 581 records, 11 articles (1 with macroeconomic
analysis and 10 with microeconomic analyses) were included. Direct medical costs
per episode for outpatients and inpatients ranged from US$4.21 to US$212.17 and
from US$163.62 to US$4577.83, respectively, across distinct influenza illnesses.
The overall burden of influenza was between US$31.1 and US$83.6 million per year
and 50-53% of these estimates referred to lost productivity. Costs of screening
for an outbreak of influenza at an 8-bed-intensive-care-unit hospital was
US$38242.75 per year. Labor-sensitive sectors such as services were the most
affected part of the Thai economy. High economic burden tended to occur among
children and older adults with co-morbidities and to be related to
complications, non-vaccinated status, and severe influenza illness. Strategies
involving prevention, limit of transmission, and treatment focusing on
aforementioned patients’ factors, containment of hospitalization expenses and
quarantine process, and assistance on labor-sensitive economy sectors are likely
to reduce the economic burden of influenza. However, a research gap exists
regarding knowledge about the economic burden of influenza in Thailand.
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Affiliation(s)
- S Kiertiburanakul
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - W Phongsamart
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - T Tantawichien
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - W Manosuthi
- Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, Nonthaburi, Thailand
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Pallas SW, Ahmeti A, Morgan W, Preza I, Nelaj E, Ebama M, Levin A, Lafond KE, Bino S. Program cost analysis of influenza vaccination of health care workers in Albania. Vaccine 2020; 38:220-227. [PMID: 31669063 PMCID: PMC10621071 DOI: 10.1016/j.vaccine.2019.10.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/01/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Since 2012, WHO has recommended influenza vaccination for health care workers (HCWs), which has different costs than routine infant immunization; however, few cost estimates exist from low- and middle-income countries. Albania, a middle-income country, has self-procured influenza vaccine for some HCWs since 2014, supplemented by vaccine donations since 2016 through the Partnership for Influenza Vaccine Introduction (PIVI). We conducted a cost analysis of HCW influenza vaccination in Albania to inform scale-up and sustainability decisions. METHODS We used the WHO's Seasonal Influenza Immunization Costing Tool (SIICT) micro-costing approach to estimate incremental costs from the government perspective of facility-based vaccination of HCWs in Albania with trivalent inactivated influenza vaccine for the 2018-19 season based on 2016-17 season data from administrative records, key informant consultations, and a convenience sample of site visits. Scenario analyses varied coverage, vaccine presentation, and vaccine prices. RESULTS In the baseline scenario, 13,377 HCWs (70% of eligible HCWs) would be vaccinated at an incremental financial cost of US$61,296 and economic cost of US$161,639. Vaccine and vaccination supplies represented the largest share of financial (89%) and economic costs (44%). Per vaccinated HCW financial cost was US$4.58 and economic cost was US$12.08 including vaccine and vaccination supplies (US$0.49 and US$6.76 respectively without vaccine and vaccination supplies). Scenarios with higher coverage, pre-filled syringes, and higher vaccine prices increased total economic and financial costs, although the economic cost per HCW vaccinated decreased with higher coverage as some costs were spread over more HCWs. Across all scenarios, economic costs were <0.07% of Albania's estimated government health expenditure, and <5.07% of Albania's estimated immunization program economic costs. CONCLUSIONS Cost estimates can help inform decisions about scaling up influenza vaccination for HCWs and other risk groups.
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Affiliation(s)
| | | | | | - Iria Preza
- Institute of Public Health, Tirana, Albania
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