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Nham E, Seong H, Hyun H, Yoon JG, Noh JY, Cheong HJ, Kim WJ, Kim E, Choi L, Lee JM, Song JY. Cost-effectiveness of high-dose quadrivalent influenza vaccine versus standard-dose quadrivalent influenza vaccine for older people in a country with high influenza vaccination rate. Hum Vaccin Immunother 2023; 19:2266233. [PMID: 37964587 PMCID: PMC10653759 DOI: 10.1080/21645515.2023.2266233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/29/2023] [Indexed: 11/16/2023] Open
Abstract
The highdose quadrivalent influenza vaccine (QIVHD) has shown improved protection against influenza and its complications in older adults. We aimed to evaluate the costeffectiveness of QIVHD compared with QIVSD among Korean adults aged ≥ 65 years in reducing influenzarelated disease burden. We evaluated the 2016/2017 and 2017/2018 seasons and their average values using a static decision tree model. The difference in efficacy between standard-dose (SD) and high-dose (HD) was calculated based on the results of a clinical trial comparing Fluzone® High-Dose Vaccine and Fluzone® Vaccine in older adults. Incremental cost-effectiveness ratios (ICERs) were assessed from the healthcare system perspective. A discount rate of 4.5% was applied to life-year-gained (LYG) values and utilities. We performed deterministic and probabilistic sensitivity analyses to account for both epidemiological and economic sources of uncertainty. In the analysis of the 2017/2018 season, the QIV-HD strategy generated an excess of 0.00182 life-years (Lys)/person and 0.003953 quality-adjusted life-years (QALYs)/person compared with QIV-SD. The ICER was 6,467.56 United States Dollars (USD)/QALY. In the analysis from the 2016/2017 season, QIV-HD caused a surplus of 0.00117 Lys/person and 0.003272 QALYs/person compared with QIV-SD. ICER was 7,902.46 USD /QALY. From the average data of the 2016/2017 and 2017/2018 seasons, an excess of 0.00147 Lys/person and 0.003561 QALYs/person were generated using QIV-HD compared with QIV-SD, while the ICER was 7,190.44 USD /QALY. From the healthcare system perspective, QIV-HD was a more cost-effective vaccination option in reducing influenza-related disease burden and healthcare costs in Koreans aged ≥ 65 years compared with QIV-SD.
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Affiliation(s)
- Eliel Nham
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- RWE, Vaccine Innovation Center-KU Medicine (VIC-K), Seoul, Republic of Korea
| | - Hye Seong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- RWE, Vaccine Innovation Center-KU Medicine (VIC-K), Seoul, Republic of Korea
| | - Hakjun Hyun
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- RWE, Vaccine Innovation Center-KU Medicine (VIC-K), Seoul, Republic of Korea
| | - Jin Gu Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- RWE, Vaccine Innovation Center-KU Medicine (VIC-K), Seoul, Republic of Korea
| | - Ji Yun Noh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- RWE, Vaccine Innovation Center-KU Medicine (VIC-K), Seoul, Republic of Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- RWE, Vaccine Innovation Center-KU Medicine (VIC-K), Seoul, Republic of Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- RWE, Vaccine Innovation Center-KU Medicine (VIC-K), Seoul, Republic of Korea
| | - Eugene Kim
- Market Access, Syneos Health Korea, Seoul, Korea
| | - Leejung Choi
- Market Access, Syneos Health Korea, Seoul, Korea
| | | | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- RWE, Vaccine Innovation Center-KU Medicine (VIC-K), Seoul, Republic of Korea
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Aljunid SM, Mad Tahir NS, Ismail A, Abdul Aziz AF, Azzeri A, Zafirah SA, Aizuddin AN. Cost effectiveness of quadrivalent influenza vaccines in the elderly population of Malaysia. Sci Rep 2023; 13:18771. [PMID: 37907537 PMCID: PMC10618214 DOI: 10.1038/s41598-023-46079-y] [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: 04/12/2023] [Accepted: 10/27/2023] [Indexed: 11/02/2023] Open
Abstract
The economic burden of influenza is a significant issue within healthcare system, related to higher medical costs particularly among the elderly. Yet, influenza vaccination rates in the elderly in Malaysia were considerably low as it is not part of Malaysia's national immunization program, with substantial mortality and morbidity consequences. Therefore, we conducted a cost-effectiveness analysis of quadrivalent influenza vaccine (QIV) for the elderly in Malaysia compared with the current no-vaccination policy. A static cost-utility model, with a lifetime horizon based on age, was used for the analysis to assess the cost-effectiveness and health outcomes associated with QIV. Univariate and probabilistic sensitivity analyses were performed to test the effects of variations in the parameters. The use of QIV in Malaysia's elderly population would prevent 66,326 potential influenza cases and 888 potential deaths among the elderly, leading to 10,048 potential quality-adjusted life years (QALYs) gained. The QIV would also save over USD 4.4 million currently spent on influenza-related hospitalizations and reduce productivity losses by approximately USD 21.6 million. The ICER per QALY gained from a third-party payer's perspective would be USD 2216, which is lower than the country's gross domestic product per capita. A QIV-based vaccination program in the elderly was found to be highly cost-effective, therefore would reduce the financial burden of managing influenza and reduce pre-mature death related to this disease.
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Affiliation(s)
- Syed Mohamed Aljunid
- Department of Public Health and Community Medicine, School of Medicine, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia.
- International Centre for Casemix and Clinical Coding, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia.
| | - Nur Syazana Mad Tahir
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia.
- Federal Government Administrative Centre, Ministry of Health Malaysia, Putrajaya, Malaysia.
| | - Aniza Ismail
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Aznida Firzah Abdul Aziz
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Amirah Azzeri
- Public Health Unit, Department of Primary Health Care, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, Malaysia
| | - S A Zafirah
- Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, Malaysia
| | - Azimatun Noor Aizuddin
- International Centre for Casemix and Clinical Coding, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
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Postma M, Fisman D, Giglio N, Márquez-Peláez S, Nguyen VH, Pugliese A, Ruiz-Aragón J, Urueña A, Mould-Quevedo J. Real-World Evidence in Cost-Effectiveness Analysis of Enhanced Influenza Vaccines in Adults ≥ 65 Years of Age: Literature Review and Expert Opinion. Vaccines (Basel) 2023; 11:1089. [PMID: 37376478 DOI: 10.3390/vaccines11061089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
Influenza vaccination can benefit most populations, including adults ≥ 65 years of age, who are at greater risk of influenza-related complications. In many countries, enhanced vaccines, such as adjuvanted, high-dose, and recombinant trivalent/quadrivalent influenza vaccines (aTIV/aQIV, HD-TIV/HD-QIV, and QIVr, respectively), are recommended in older populations to provide higher immunogenicity and increased relative vaccine efficacy/effectiveness (rVE) than standard-dose vaccines. This review explores how efficacy and effectiveness data from randomized controlled trials and real-world evidence (RWE) are used in economic evaluations. Findings from published cost-effectiveness analyses (CEA) on enhanced influenza vaccines for older adults are summarized, and the assumptions and approaches used in these CEA are assessed alongside discussion of the importance of RWE in CEA. Results from many CEA showed that adjuvanted and high-dose enhanced vaccines were cost-effective compared with standard vaccines, and that differences in rVE estimates and acquisition price may drive differences in cost-effectiveness estimates between enhanced vaccines. Overall, RWE and CEA provide clinical and economic rationale for enhanced vaccine use in people ≥ 65 years of age, an at-risk population with substantial burden of disease. Countries that consider RWE when making vaccine recommendations have preferentially recommended aTIV/aQIV, as well as HD-TIV/HD-QIV and QIVr, to protect older individuals.
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Affiliation(s)
- Maarten Postma
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, P.O. Box 72, 9700 AB Groningen, The Netherlands
- Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, 9713 AB Groningen, The Netherlands
- Centre of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, 40132 Bandung, Indonesia
| | - David Fisman
- Dalla Lana School of Public Health, Toronto, ON M5T 3M7, Canada
| | - Norberto Giglio
- Hospital de Niños Ricardo Gutièrrez, Buenos Aires 1425, Argentina
| | - Sergio Márquez-Peláez
- Department of Economics, Economic Analysis, Faculty of Business Pablo de Olavide University, 41013 Seville, Spain
| | | | - Andrea Pugliese
- Department of Mathematics, University of Trento, 38123 Trento, Italy
| | | | - Analia Urueña
- Centro de Estudios para la Prevención y Control de Enfermedades Transmisibles, Universidad Isalud, Buenos Aires C1095AAS, Argentina
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Warmath CR, Ortega-Sanchez IR, Duca LM, Porter RM, Usher MG, Bresee JS, Lafond KE, Davis WW. Comparisons in the Health and Economic Assessments of Using Quadrivalent Versus Trivalent Influenza Vaccines: A Systematic Literature Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:768-779. [PMID: 36436790 DOI: 10.1016/j.jval.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 10/05/2022] [Accepted: 11/16/2022] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Seasonal influenza vaccines protect against 3 (trivalent influenza vaccine [IIV3]) or 4 (quadrivalent influenza vaccine [IIV4]) viruses. IIV4 costs more than IIV3, and there is a trade-off between incremental cost and protection. This is especially the case in low- and middle-income countries (LMICs) with limited budgets; previous reviews have not identified studies of IIV4-IIV3 comparisons in LMICs. We summarized the literature that compared health and economic outcomes of IIV4 and IIV3, focused on LMICs. METHODS We systematically searched 5 databases for articles published before October 6, 2021, that modeled health or economic effects of IIV4 versus IIV3. We abstracted data and compared findings among countries and models. RESULTS Thirty-eight studies fit our selection criteria; 10 included LMICs. Most studies (N = 31) reported that IIV4 was cost-saving or cost-effective compared with IIV3; we observed no difference in health or economic outcomes between LMICs and other countries. Based on cost differences of influenza vaccines, only one study compared coverage of IIV3 with IIV4 and reported that the maximum IIV4 price that would still yield greater public health impact than IIV3 was 13% to 22% higher than IIV3. CONCLUSIONS When vaccination coverage with IIV4 and IIV3 is the same, IIV4 tends to be not only more effective but more cost-effective than IIV3, even with relatively high price differences between vaccine types. Alternatively, where funding is limited as in most LMICs, higher vaccine coverage can be achieved with IIV3 than IIV4, which could result in more favorable health and economic outcomes.
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Affiliation(s)
- Clara R Warmath
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Ismael R Ortega-Sanchez
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lindsey M Duca
- Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rachael M Porter
- Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Molly G Usher
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Joseph S Bresee
- Partnership for Influenza Vaccine Introduction, The Task Force for Global Health, Decatur, GA, USA
| | - Kathryn E Lafond
- Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
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Bianculli PM, Bellier L, Mangado IO, Pérez CG, Mieres G, Lazarov L, Petitjean A, Dibarboure H, Lopez JG. Switching from trivalent to quadrivalent inactivated influenza vaccines in Uruguay: a cost-effectiveness analysis. Hum Vaccin Immunother 2022; 18:2050653. [PMID: 35344679 PMCID: PMC9225211 DOI: 10.1080/21645515.2022.2050653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We evaluated the cost-utility of replacing trivalent influenza vaccine (TIV) with quadrivalent influenza vaccine (QIV) in the current target populations in Uruguay. An existing decision-analytic static cost-effectiveness model was adapted for Uruguay. The population was stratified into age groups. Costs and outcomes were estimated for an average influenza season, based on observed rates from 2013 to 2019 inclusive. Introducing QIV instead of TIV in Uruguay would avoid around 740 additional influenza cases, 500 GP consultations, 15 hospitalizations, and three deaths, and save around 300 workdays, for the same vaccination coverage during an average influenza season. Most of the influenza-related consultations and hospitalizations would be avoided among children ≤4 and adults ≥65 years of age. Using QIV rather than TIV would cost an additional ~US$729,000, but this would be partially offset by savings in consultations and hospitalization costs. The incremental cost per quality-adjusted life-year (QALY) gained with QIV would be in the order of US$18,000 for both the payor and societal perspectives, for all age groups, and around US$12,000 for adults ≥65 years of age. The main drivers influencing the incremental cost-effectiveness ratio were the vaccine efficacy against the B strains and the percentage of match each season with the B strain included in TIV. Probabilistic sensitivity analysis showed that switching to QIV would provide a favorable cost-utility ratio for 50% of simulations at a willingness-to-pay per QALY of US$20,000. A switch to QIV is expected to be cost-effective for the current target populations in Uruguay, particularly for older adults.
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Affiliation(s)
| | | | | | - Carlos Grau Pérez
- Centro de Investigaciones Económicas (CINVE), Montevideo, Uruguay.,Faculty, Universidad de la República, Montevideo, Uruguay
| | - Gustavo Mieres
- Centro de Investigaciones Económicas (CINVE), Montevideo, Uruguay
| | - Luis Lazarov
- Centro de Investigaciones Económicas (CINVE), Montevideo, Uruguay.,Faculty, Universidad de la República, Montevideo, Uruguay
| | - Audrey Petitjean
- Health Economics & Value Assessment, Sanofi Pasteur Global, Lyon, France
| | - Hugo Dibarboure
- Public Affairs, Sanofi Pasteur South Cone, Montevideo, Uruguay
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Loong D, Pham B, Amiri M, Saunders H, Mishra S, Radhakrishnan A, Rodrigues M, Yeung MW, Muller MP, Straus SE, Tricco AC, Isaranuwatchai W. Systematic Review on the Cost-Effectiveness of Seasonal Influenza Vaccines in Older Adults. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1439-1458. [PMID: 35659487 DOI: 10.1016/j.jval.2022.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 03/03/2022] [Accepted: 03/16/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Older adults are at high risk of influenza-related complications or hospitalization. The purpose of this systematic review is to assess the relative cost-effectiveness of all influenza vaccine options for older adults. METHODS This systematic review identified economic evaluation studies assessing the cost-effectiveness of influenza vaccines in adults ≥65 years of age from 5 literature databases. Two reviewers independently selected, extracted, and appraised relevant studies using the JBI Critical Appraisal Checklist for Economic Evaluations and Heyland's generalizability checklist. Costs were converted to 2019 Canadian dollars and adjusted for inflation and purchasing power parity. RESULTS A total of 27 studies were included. There were 18 comparisons of quadrivalent inactivated vaccine (QIV) versus trivalent inactivated vaccine (TIV): 5 showed QIV dominated TIV (ie, lower costs and higher health benefit), and 13 showed the results depended on willingness to pay (WTP). There were 9 comparisons of high-dose TIV (TIV-HD) versus TIV: 5 showed TIV-HD dominated TIV, and 4 showed the results depended on WTP. There were 8 comparisons of adjuvanted TIV (TIV-ADJ) versus TIV: 4 showed TIV-ADJ dominated TIV, and 4 showed the results depended on WTP. There were few pairwise comparisons among QIV, TIV-HD, and TIV-ADJ. CONCLUSIONS The evidence suggests QIV, TIV-HD, and TIV-ADJ are cost-effective against TIV for a WTP threshold of $50 000 per quality-adjusted life-year. Future studies should include new and existing vaccine options for broad age ranges and use more robust methodologies-such as real-world evaluations or modeling studies accounting for methodological, structural, and parameter uncertainty.
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Affiliation(s)
- Desmond Loong
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Ba' Pham
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Mohammadreza Amiri
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Hailey Saunders
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Sujata Mishra
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Amruta Radhakrishnan
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Myanca Rodrigues
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Health Research Methodology Graduate Program, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Man Wah Yeung
- National Advisory Committee on Immunization Secretariat, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Matthew P Muller
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Infection Prevention and Control, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Wanrudee Isaranuwatchai
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.
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Arbo A, Martinez-Cuellar C, Vazquez C, Bellier L, Adorno C, Dibarboure H, Lopez JG, Petitjean A, Bianculli P. Public health and budget impacts of switching from a trivalent to a quadrivalent inactivated influenza vaccine in Paraguay. Hum Vaccin Immunother 2022; 18:2069974. [PMID: 35543602 PMCID: PMC9302507 DOI: 10.1080/21645515.2022.2069974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This study aimed to investigate the public health and economic benefit of using a quadrivalent influenza vaccine (QIV) instead of a trivalent influenza vaccine (TIV) in past seasons in Paraguay. The budget impact of switching from TIV to QIV in the Immunization Program was also evaluated. The adapted model includes two modules. The first compared retrospectively Health and Economic outcomes resulting from the use of QIV instead of TIV. The second forecast the spending and savings that would be associated with the switch from TIV to QIV. Our findings estimate that the switch from TIV to QIV during the seasons 2012 to 2017 could have prevented around 2,600 influenza cases, 67 hospitalizations and 10 deaths. An alternative scenario using standardized estimates of the burden of influenza showed that 234 influenza-related hospitalizations and 29 deaths could have been prevented. The estimated annual budget impact of a full switch from TIV to QIV was around USD1,6 million both from the payer and societal perspectives. Those results are mainly driven by vaccine prices and coverage rate. In sum, this manuscript describes how the use of QIV instead of TIV could have prevented influenza cases and subsequent complications that led to hospitalizations and deaths. This could have generated savings for the health system and society, offsetting part of the additional investment needed to switch from TIV to QIV.
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Affiliation(s)
- Antonio Arbo
- Institute of Tropical Medicine, Faculty of Medicine, National University of Paraguay, Asunción, Paraguay
| | - Celia Martinez-Cuellar
- Institute of Tropical Medicine, Faculty of Medicine, National University of Paraguay, Asunción, Paraguay
| | - Cynthia Vazquez
- Virology Department, Laboratorio Central de Salud Pública, Asunción, Paraguay
| | - Lucile Bellier
- Health Economics and Outcomes Research, Creativ-Ceutical, London, UK
| | | | - Hugo Dibarboure
- Public Affairs, Sanofi Pasteur South Cone, Montevideo, Uruguay
| | | | - Audrey Petitjean
- Health Economics and Outcomes Research, Sanofi Pasteur, Lyon, France
| | - Pablo Bianculli
- Value & Access, Sanofi Pasteur South Cone, Buenos Aires, Argentina
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Bellier L, Petitjean A, Sarazu T, Tresierra J, Lopez JG. Cost-effectiveness analysis of switching from a trivalent to a quadrivalent inactivated influenza vaccine in the Peruvian immunisation programme. Vaccine 2021; 39:4144-4152. [PMID: 34130885 DOI: 10.1016/j.vaccine.2021.05.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Seasonal influenza is an acute respiratory infection mostly caused by type A and B influenza viruses. The severe form of the infection can be life-threatening and lead to a significant burden. Vaccination is the most efficient way of preventing influenza infections and limit this burden. OBJECTIVES To assess the cost-effectiveness of switching from a trivalent influenza vaccine (TIV) to a quadrivalent influenza vaccine (QIV) in the vaccination programme in Peru, and to evaluate the health and economic impact of reaching the vaccination coverage rate targeted by the Ministry of Health. METHODS A decision-analytic static cost-effectiveness model, was adapted to the Peruvian setting under both payer and societal perspectives. RESULTS A switch from TIV to QIV would prevent 29,126 additional cases (including 12,815 consultations), 54 hospitalisations, and 23 deaths related to influenza, mostly in the population <2 years-old and >60 years-old. This would lead to a saving of US $505,206 under the payer perspective, that would partially offset the investment necessary to introduce QIV into the immunisation programme. The resulting incremental cost-effectiveness ratio (ICER) is $16,649 per QALYs gained. The main drivers of the model results were vaccine efficacy against influenza B viruses, degree of match, vaccines prices and proportion of cases attributable to influenza B. The robustness of the results seems satisfactory as QIV has the probability of being a cost-effective strategy of 83.8% (considering a threshold of three GDP per capita). Reaching the coverage targeted by the Ministry of Health would result in health benefits and disease management savings, and lower ICERs. CONCLUSION Introducing QIV instead of TIV in the Peruvian immunisation programme is expected to be a cost-effective strategy, especially in younger children and the elderly. The benefit of QIV would be even more important if the coverage targeted by the Ministry of Health would be reached in the most vulnerable groups.
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Affiliation(s)
- Lucile Bellier
- Health Economics and Outcome Research, CreativCeutical, London, UK
| | - Audrey Petitjean
- Health Economics & Value Assessment, Sanofi Pasteur Global, Lyon, France
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9
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Net P, Colrat F, Nascimento Costa M, Bianic F, Thommes E, Alvarez FP. Estimating public health and economic benefits along 10 years of Fluzone® High Dose in the United States. Vaccine 2021; 39 Suppl 1:A56-A69. [PMID: 33509695 DOI: 10.1016/j.vaccine.2021.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 12/18/2020] [Accepted: 01/04/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study was to estimate the public health and economic benefits (from a Medicare perspective) of Fluzone High-Dose® in the US elderly population, since its introduction in 2010. METHODS A budget impact model was developed using a decision tree framework and applied over 9 influenza seasons (2010/11 to 2018/19). The decision tree model was designed to capture influenza cases, hospitalizations possibly related to influenza or laboratory confirmed influenza, and influenza-related deaths. The analysis included influenza vaccines recommended by ACIP since 2010: SD TIV (trivalent), SD QIV (quadrivalent), HD TIV, aTIV (adjuvanted), ccQIV (cell-cultured). Two strategies were compared to evaluate the impact of HD TIV: a 'with HD TIV' strategy representative of the US vaccine landscape, and a 'without HD TIV' where the absence of HD TIV was modelled. Clinical and economic inputs were based on public US data from the CDC and national databases, while data on vaccine effectiveness were extracted from published literature and clinical trials. The impact of HD TIV was further explored in five scenario analyses and deterministic sensitivity analyses (DSA). RESULTS Over 10 years, it is estimated that HD TIV resulted in an averted 1,333,479 influenza cases, 769,476 medical visits, 40,004 ED presentations, 520,342 cardiorespiratory hospitalizations and 73,689 deaths and generated an absolute $4.6 billion in savings, translating into a return on investment of 214.4%. Hospitalizations costs represented 98.4% and 98.3% of the management costs in the 'with HD TIV' strategy and 'without HD TIV' strategy respectively. Hospitalizations and HD TIV relative vaccine efficacy vs SD TIV as a major cost driver were further confirmed in scenario analysis and DSA. HD TIV remained cost saving under all the scenarios. CONCLUSION The model showed that HD TIV higher efficacy translated into increased averted health and economic outcomes. HD TIV represented a cost saving intervention from a payer perspective since its introduction.
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Amiche A, Tanriover MD, Bellier L, Ugur B, Akin L. Cost Utility of Switching From Trivalent to Quadrivalent Influenza Vaccine in Turkey. Value Health Reg Issues 2021; 25:15-22. [PMID: 33485248 DOI: 10.1016/j.vhri.2020.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/26/2020] [Accepted: 11/03/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Trivalent influenza vaccines (TIVs) are widely used but protect against only 1 of the 2 co-circulating influenza B virus lineages. Quadrivalent influenza vaccines (QIVs) include a B strain from each lineage to overcome mismatches. The main objective of this study was to determine the cost-utility and budget impact of switching from vaccination with TIV to QIV in the population recommended for influenza vaccination in Turkey. METHODS A static cohort cost-effectiveness model was developed to predict influenza-related costs and outcomes under a QIV versus a TIV program during an influenza season. The model was informed by data from Turkey on influenza strain distribution, influenza-attributable outcomes, and associated costs over the seasons 2010/2011 to 2016/2017. The effectiveness of each strategy was measured through quality-adjusted life-years (QALYs), and comparisons were based on the incremental cost-effectiveness ratio. RESULTS In an average influenza season, the model showed that switching from TIV to QIV would prevent an additional 15 092 cases of influenza, 6311 general practitioner visits, 94 hospitalizations, 13 deaths, and gain 440 QALYs. From the societal perspective, this amounted to total cost savings of international dollars (I$) 1102 710 (US$388 643). The incremental cost-effectiveness ratio when using QIV over TIV was I$55 248/QALY gained. Switching to QIV is mostly cost-effective among older adults with I$36 413.38/QALY. Sensitivity analysis showed that vaccine effectiveness, B strain mismatch, and influenza visits highly impact the cost-effectiveness results. CONCLUSION Switching from TIV to QIV is likely to be cost-effective in Turkey, yet highly dependent on the severity of the influenza season, B strain epidemiology, and vaccine effectiveness.
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Affiliation(s)
| | - Mine Durusu Tanriover
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Zeevat F, Crépey P, Dolk FCK, Postma AJ, Breeveld-Dwarkasing VNA, Postma MJ. Cost-Effectiveness of Quadrivalent Versus Trivalent Influenza Vaccination in the Dutch National Influenza Prevention Program. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:3-10. [PMID: 33431150 DOI: 10.1016/j.jval.2020.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 10/16/2020] [Accepted: 11/02/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES As of 2019, quadrivalent influenza vaccine (QIV) has replaced trivalent influenza vaccine (TIV) in the national immunization program in The Netherlands. Target groups are individuals of 60+ years of age and those with chronic diseases. The objective was to estimate the incremental break-even price of QIV over TIV at a threshold of €20 000 per quality-adjusted life-year (QALY). METHODS An age-structured compartmental dynamic model was adapted for The Netherlands to assess health outcomes and associated costs of vaccinating all individuals at higher risk for influenza with QIV instead of TIV over the seasons 2010 to 2018. Influenza incidence rates were derived from a global database. Other parameters (probabilities, QALYs and costs) were extracted from the literature and applied according to Dutch guidelines. A threshold of €20 000 per QALY was applied to estimate the incremental break-even prices of QIV versus TIV. Sensitivity analyses were performed to test the robustness of the model outcomes. RESULTS Retrospectively, vaccination with QIV instead of TIV could have prevented on average 9500 symptomatic influenza cases, 2130 outpatient visits, 84 hospitalizations, and 38 deaths per year over the seasons 2010 to 2018. This translates into 385 QALYs and 398 life-years potentially gained. On average, totals of €431 527 direct and €2 388 810 indirect costs could have been saved each year. CONCLUSION Using QIV over TIV during the influenza seasons 2010 to 2018 would have been cost-effective at an incremental price of maximally €3.81 (95% confidence interval, €3.26-4.31). Sensitivity analysis showed consistent findings on the incremental break-even price in the same range.
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Affiliation(s)
- Florian Zeevat
- Department of Health Sciences, University of Groningen, University Medical Centre, Groningen, The Netherlands.
| | - Pascal Crépey
- Department of Quantitative Methods in Public Health, University of Rennes, Rennes, France
| | - F Christiaan K Dolk
- Unit of PharmacoTherapy, Epidemiology, and Economics, University of Groningen, Department of Pharmacy, Groningen, The Netherlands
| | | | | | - Maarten J Postma
- Department of Health Sciences, University of Groningen, University Medical Centre, Groningen, The Netherlands; Unit of PharmacoTherapy, Epidemiology, and Economics, University of Groningen, Department of Pharmacy, Groningen, The Netherlands; Department of Economics, Econometrics, and Finance, University of Groningen, Faculty of Economics and Business, Groningen, The Netherlands
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Ruiz-Palacios GM, Beigel JH, Guerrero ML, Bellier L, Tamayo R, Cervantes P, Alvarez FP, Galindo-Fraga A, Aguilar-Ituarte F, Lopez JG. Public health and economic impact of switching from a trivalent to a quadrivalent inactivated influenza vaccine in Mexico. Hum Vaccin Immunother 2020; 16:827-835. [PMID: 31851570 PMCID: PMC7227722 DOI: 10.1080/21645515.2019.1678997] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/17/2019] [Accepted: 10/06/2019] [Indexed: 12/19/2022] Open
Abstract
Most influenza vaccines in Mexico are trivalent, containing two influenza A strains and a single B strain. Quadrivalent influenza vaccines (QIVs) extend protection by including an additional B strain to cover both co-circulating B lineages. Here, we retrospectively estimated how a switch to QIV in Mexico would have impacted influenza-related health outcomes over the 2010/2011 to 2015/2016 influenza seasons, and prospectively estimated the budget impact of using QIV in Mexico's national immunization program from 2016/2017 to 2020/2021. For the retrospective estimation, we used an age-stratified static model incorporating Mexico-specific input parameters. For the prospective estimation, we used a budget impact model based on retrospective attack rates considering predicted future vaccination coverage. Between 2010/2011 and 2015/2016, a switch to QIV would have prevented 270,596 additional influenza cases, 102,000 general practitioner consultations, 140,062 days of absenteeism, 3,323 hospitalizations, and 312 deaths, saving Mex$214 million (US$10.8 million) in third-party payer costs. In the prospective analysis, a switch to QIV was estimated to prevent an additional 225,497 influenza cases, 85,000 general practitioner consultations, 116,718 days of absenteeism, 2,769 hospitalizations, and 260 deaths, saving Mex$178 million (US$9 million) in third-party payer costs over 5 years. Compared to the trivalent vaccine, the benefit and costs saved with QIV were sensitive to the distribution of influenza A vs. B cases and trivalent vaccine effectiveness against the mismatched B strain. These results suggest switching to QIV in Mexico would benefit healthcare providers and society by preventing influenza cases, morbidity, and deaths, and reducing associated use of medical resources.
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Affiliation(s)
- Guillermo M. Ruiz-Palacios
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - John H. Beigel
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health, Bethesda, MD, US
| | - Maria Lourdes Guerrero
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | - Arturo Galindo-Fraga
- Subdirección de Epidemiología Hospitalaria y Control de Calidad de la Atención, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Maltezou HC, Kossyvakis A, Lytras T, Exindari M, Christoforidi M, Mentis A, Gioula G. Circulation of Influenza Type B Lineages in Greece During 2005-2015 and Estimation of Their Impact. Viral Immunol 2020; 33:94-98. [PMID: 31905328 DOI: 10.1089/vim.2019.0110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The past decades influenza B lineages Victoria and Yamagata cocirculated. Our aim was to estimate the distribution of the two lineages circulating in Greece and any possible mismatching with vaccine influenza B strains. We studied 490 laboratory-confirmed influenza B nonsevere acute respiratory infection (non-SARI) cases diagnosed in the two National Influenza Reference Laboratories by reverse transcriptase polymerase chain reaction from July 1, 2005 to June 30, 2015 and 100 influenza B SARI cases diagnosed from July 1, 2011 to June 30, 2015. Median matching between the circulating influenza B lineages and the vaccine influenza B strains was 19.2% (range: 0-100%) for non-SARI cases during 2005-2015 and 67.6% (range: 41.2-94.1%) for SARI cases during 2011-2015. In two influenza seasons (2005-2006 and 2006-2007), complete lineage mismatch between influenza B non-SARI cases and influenza B vaccine strains was found. We estimated that 5, 12, or 16 laboratory-confirmed SARI cases could have been prevented by quadrivalent influenza inactivated vaccine (QIV) during the 2011-2012 season and 1, 2, or 3 SARI cases during the 2014-2015 season, with a vaccination coverage rate of 70% and a vaccine effectiveness of 20%, 50%, or 70%, respectively. Significant cocirculation of Victoria and Yamagata B strains and mismatching with vaccine influenza B strains were found during 2005-2015 in Greece. The wide use of a QIV instead of a TIV will confer additional immunity and therefore protection against influenza B, and it is expected to prevent several SARI cases annually. Our findings strongly support the recommendations for using QIV.
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Affiliation(s)
- Helena C Maltezou
- Department for Interventions in Healthcare Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Athanassios Kossyvakis
- National Influenza Reference Laboratory for Southern Greece, Hellenic Pasteur Institute, Athens, Greece
| | - Theodore Lytras
- Office of Scientific Collaborators, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Maria Exindari
- National Influenza Reference Laboratory for Northern Greece, Microbiology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Christoforidi
- National Influenza Reference Laboratory for Northern Greece, Microbiology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Mentis
- National Influenza Reference Laboratory for Southern Greece, Hellenic Pasteur Institute, Athens, Greece
| | - Georgia Gioula
- National Influenza Reference Laboratory for Northern Greece, Microbiology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Wilson KJ, Brown HS, Patel U, Tucker D, Becker K. Cost-effectiveness of a comprehensive immunization program serving high-risk, uninsured adults. Prev Med 2020; 130:105860. [PMID: 31678176 DOI: 10.1016/j.ypmed.2019.105860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 10/01/2019] [Accepted: 10/08/2019] [Indexed: 10/25/2022]
Abstract
Despite the numerous social and economic benefits of vaccination, adult immunization rates fall far short of recommended levels costing the United States $9 billion annually in health care expenditures and reduced productivity. While it is well recognized that childhood immunization is highly cost-effective, the economic impact of adult immunization programs varies by disease and is influenced by population demographics. This study aimed to assess the cost-effectiveness of a comprehensive adult immunization program serving high-need populations delivered by a local health department (LHD) in partnership with community organizations. We modeled incremental cost-effectiveness taking the payer perspective of each vaccine separately in simulated cohorts of 100,000 over a 20-year horizon using data provided by the LHD and data from the published literature. We adjusted the results to align with actual program delivery and used them to estimate an incremental cost-effectiveness ratio (ICER) for the entire program. We assessed the effects of varying our base model parameters in univariate sensitivity analyses. We discounted benefits and life years saved (LYS) at 3% and adjusted results to 2016 US$. Four of seven disease models were cost-effective (using a $100,000 CE threshold) with ICERS ranging from $14,260 to $79,022/LYS. Sensitivity analyses did not substantially impact the results. The ICER for program as a whole was $67,940/LYS. A community-delivered comprehensive immunization program serving uninsured, low income, high-risk adults is a cost-effective investment even when most do not receive the full regimen of some vaccines.
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Affiliation(s)
- Kimberly J Wilson
- University of Texas Health Science Center School of Public Health, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, United States of America.
| | - H Shelton Brown
- University of Texas Health Science Center School of Public Health, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, United States of America.
| | - Ujas Patel
- University of Texas Health Science Center School of Public Health, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, United States of America
| | - Debbie Tucker
- Austin Public Health, 15 Waller Street, Austin, TX 78701, United States of America.
| | - Kurt Becker
- Austin Public Health, 15 Waller Street, Austin, TX 78701, United States of America.
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Emukule GO, Otiato F, Nyawanda BO, Otieno NA, Ochieng CA, Ndegwa LK, Muturi P, Bigogo G, Verani JR, Muthoka PM, Hunsperger E, Chaves SS. The Epidemiology and Burden of Influenza B/Victoria and B/Yamagata Lineages in Kenya, 2012-2016. Open Forum Infect Dis 2019; 6:ofz421. [PMID: 31660376 PMCID: PMC6804754 DOI: 10.1093/ofid/ofz421] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/27/2019] [Indexed: 12/01/2022] Open
Abstract
Background The impact of influenza B virus circulation in Sub-Saharan Africa is not well described. Methods We analyzed data from acute respiratory illness (ARI) in Kenya. We assessed clinical features and age-specific hospitalization and outpatient visit rates by person-years for influenza B/Victoria and B/Yamagata and the extent to which circulating influenza B lineages in Kenya matched the vaccine strain component of the corresponding season (based on Northern Hemisphere [October–March] and Southern Hemisphere [April–September] vaccine availability). Results From 2012 to 2016, influenza B represented 31% of all influenza-associated ARIs detected (annual range, 13–61%). Rates of influenza B hospitalization and outpatient visits were higher for <5 vs ≥5 years. Among <5 years, B/Victoria was associated with pneumonia hospitalization (64% vs 44%; P = .010) and in-hospital mortality (6% vs 0%; P = .042) compared with B/Yamagata, although the mean annual hospitalization rate for B/Victoria was comparable to that estimated for B/Yamagata. The 2 lineages co-circulated, and there were mismatches with available trivalent influenza vaccines in 2/9 seasons assessed. Conclusions Influenza B causes substantial burden in Kenya, particularly among children aged <5 years, in whom B/Victoria may be associated with increased severity. Our findings suggest a benefit from including both lineages when considering influenza vaccination in Kenya.
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Affiliation(s)
- Gideon O Emukule
- Centers for Disease Control and Prevention - Kenya Country Office, Nairobi, Kenya
| | | | | | - Nancy A Otieno
- Kenya Medical Research Institute, Kisumu and Nairobi, Kenya
| | | | - Linus K Ndegwa
- Centers for Disease Control and Prevention - Kenya Country Office, Nairobi, Kenya
| | | | - Godfrey Bigogo
- Kenya Medical Research Institute, Kisumu and Nairobi, Kenya
| | - Jennifer R Verani
- Centers for Disease Control and Prevention - Kenya Country Office, Nairobi, Kenya
| | | | - Elizabeth Hunsperger
- Centers for Disease Control and Prevention - Kenya Country Office, Nairobi, Kenya
| | - Sandra S Chaves
- Centers for Disease Control and Prevention - Kenya Country Office, Nairobi, Kenya.,Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Shasha D, Valinsky L, Hershkowitz Sikron F, Glatman-Freedman A, Mandelboim M, Toledano A, Paran Y, Ben-Ami R, Goldman D. Quadrivalent versus trivalent influenza vaccine: clinical outcomes in two influenza seasons, historical cohort study. Clin Microbiol Infect 2019; 26:101-106. [PMID: 31108229 DOI: 10.1016/j.cmi.2019.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The quadrivalent influenza vaccine (QIV) contains two influenza B antigens (one of each B lineage), while the trivalent vaccine (TIV) contains solely one. As a result, a mismatch between the circulating B lineage and the lineage in the TIV occurs frequently. We aimed to compare the frequency of clinically significant outcomes in a large cohort of vaccinees receiving either TIV or QIV. METHODS Historical cohort study of all inactivated influenza vaccinees (aged 3 years and older) in a Health Maintenance Organization insuring 1.2 million individuals, over two influenza seasons in which both vaccines were provided non-selectively. Primary outcome was hospital admissions during the influenza season. Multivariate analysis was performed using logistic regression to adjust for relevant covariates. RESULTS Our cohort included 150 518 and 168 296 vaccinees in the first (S1) and second season (S2), respectively. The two influenza seasons were characterized by high Influenza B activity. Of those vaccinated with QIV, 2074 of 49 726 (4.2%) and 6563 of 121 741 (5.4%) were hospitalized compared with 7378 of 100 792 (7.3%) and 3372 of 46 555 (7.2%) of those vaccinated with TIV (S1 and S2, respectively). After multivariate analysis adjusting for several covariates (gender, age, socioeconomic status, chronic morbidity, timing of vaccination), compared with TIV recipients, QIV vaccinees had lower odds for hospitalization (OR = 0.92, 95% CI 0.87-0.98 and OR = 0.89, 95% CI 0.85-0.93) or emergency department visit (OR = 0.91, 95% CI 0.87-0.95 and OR = 0.84, 95% CI 0.81-0.87) in S1 and S2, respectively (p < 0.001). Lower odds of mortality and influenza-like illness were also observed in S2 (OR = 0.61, 95% CI 0.50-0.75 and OR = 0.92, 95% CI 0.90-0.95, respectively). CONCLUSIONS In seasons with relatively high influenza B activity, QIV appeared more protective than TIV in Israel.
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Affiliation(s)
- D Shasha
- Meuhedet Health Services, Tel-Aviv, Israel; Infectious Diseases Unit, Tel-Aviv Sourasky Medical Centre, Tel-Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - L Valinsky
- Meuhedet Health Services, Tel-Aviv, Israel
| | | | - A Glatman-Freedman
- Israel Centre for Disease Control, Israel Ministry of Health, Tel Hashomer, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Mandelboim
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Central Virology Laboratory, Chaim Sheba Medical Centre, Israel Ministry of Health, Tel-Hashomer, Israel
| | - A Toledano
- Meuhedet Health Services, Tel-Aviv, Israel
| | - Y Paran
- Infectious Diseases Unit, Tel-Aviv Sourasky Medical Centre, Tel-Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - R Ben-Ami
- Infectious Diseases Unit, Tel-Aviv Sourasky Medical Centre, Tel-Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - D Goldman
- Meuhedet Health Services, Tel-Aviv, Israel
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Kim YK, Song JY, Jang H, Kim TH, Koo H, Varghese L, Han E. Cost Effectiveness of Quadrivalent Influenza Vaccines Compared with Trivalent Influenza Vaccines in Young Children and Older Adults in Korea. PHARMACOECONOMICS 2018; 36:1475-1490. [PMID: 30251078 PMCID: PMC6244612 DOI: 10.1007/s40273-018-0715-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Trivalent influenza vaccines (TIVs) are currently reimbursed for subjects aged ≥ 65 years and children between 6 and 59 months of age under a national immunization program in South Korea. Quadrivalent influenza vaccines (QIVs) are expected to address the potential problem of influenza B-lineage mismatch for TIVs. OBJECTIVE The objective of this analysis was to compare the cost effectiveness of QIV versus TIV in children aged 6-59 months and older adults ≥ 65 years of age in South Korea. METHODS A 1-year static population model was employed to compare the costs and outcomes of a QIV vaccination program compared with TIV in children aged 6-59 months and older adults ≥ 65 years of age in South Korea. Influenza-related parameters (probabilities, health resource use, and costs) were derived from an analysis of the National Health Insurance System claims database between 2010 and 2013 under a broad and narrow set of International Classification of Diseases, Tenth Revision (ICD-10) codes used to identify influenza. Other inputs were extracted from published literature. Incremental cost-effectiveness ratios (2016 South Korean Won [KRW] per quality-adjusted life-year [QALY] gained) were estimated using a 'limited' societal perspective as per the Korean pharmacoeconomic guidelines. QALYs lost due to premature mortality were discounted at 5% annually. RESULTS For both age groups combined, under the narrow definition of influenza, QIV is expected to prevent nearly 16,000 (2923 in children and 13,011 in older adults) medically attended influenza cases, nearly 8000 (672 in children, 7048 in older adults) cases of complications, and over 230 (0 in children, 238 in older adults) deaths annually compared with TIV. The impact of using QIV versus TIV in this setting translates into savings of KRW 24 billion (KRW 0.6 billion in children, KRW 23.4 billion in older adults) in annual medical costs, and over 2100 (18 in children, 2084 in older adults) QALYs. Under the broad definition, the corresponding results are over 190,000 (50,697 in children, 140,644 in older adults) influenza cases, over 37,000 (12,623 in children, 24,526 in older adults) complications, 270 deaths (0 in children, 270 in older adults), KRW 94.22 billion (KRW 16 billion in children, KRW 78.2 billion in older adults), and over 3500 QALYs saved (316 in children, 3260 in older adults). CONCLUSION The use of QIV over TIV was estimated to not be cost effective in children 6-59 months of age, but cost saving in older adults, using the narrow definition of influenza; however, QIV use was cost saving in both age groups using the broad definition. QIV is expected to yield more benefits in older adults ≥ 65 years of age than in children aged 6-59 months due to higher influenza-related mortality and costs among the older adults. Further analyses considering the indirect effects of influenza vaccination in children are required.
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Affiliation(s)
- Yun-Kyung Kim
- Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Joon Young Song
- Division of Infectious Diseases, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | | | - Tae Hyun Kim
- Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Heejo Koo
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, Republic of Korea
| | | | - Euna Han
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, Republic of Korea.
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, 162-1 Songdo-Dong, Yeonsu-Gu, Incheon, Republic of Korea.
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López Trigo JA, López Mongil R, Mariano Lázaro A, Mato Chaín G, Moreno Villajos N, Ramos Cordero P. [Seasonal flu vaccination for older people: Evaluation of the quadrivalent vaccine. Positioning report]. Rev Esp Geriatr Gerontol 2018; 53 Suppl 2:185-202. [PMID: 30107941 DOI: 10.1016/j.regg.2018.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 06/22/2018] [Indexed: 01/08/2023]
Abstract
Influenza is a significant health problem, particularly in those persons susceptible to having associated complications, older people, children less than 2 years, patients with chronic diseases, immunocompromised patients, and pregnant women. But influenza also has a large impact on the health system, with an increase in the healthcare demand and a spectacular increase in outpatient visits, overloading the emergency and hospital services. During epidemic outbreaks, the hospital admission rates of people over 65 years are at a maximum, and the mortality notified for the 2017/2018 influenza season was 960 deaths. The seasonal anti-influenza vaccine is the method with a better cost-effective ratio of primary prevention of influenza, reducing associated respiratory diseases, the number of hospital admissions, and deaths in high risk individuals, as well as work absenteeism in adults. In the last few years, influenza B has received little attention in the scientific literature, although in the periods between epidemics influenza B can be one of the main causes of seasonal epidemics, causing considerable morbidity and mortality and an increase in costs. The quadrivalent vaccine has a second-line immunological protection against influenza B, and according to a critical review of the scientific literature, it provides wider protection without affecting immunogenicity of the other three vaccine strains common to the trivalent and tetravalent vaccine. The quadrivalent vaccine is cost-effective in reducing the number of influenza cases, and is always a worthwhile intervention, with a significant cost saving for the health system and for society, by reducing the hospital admission rates and mortality associated with the complications of influenza. Supplement information: This article is part of a supplement entitled 'Seasonal flu vaccination for older people: Evaluation of the quadrivalent vaccine' which is sponsored by Sanofi-Aventis, S.A.
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Affiliation(s)
- José Antonio López Trigo
- Geriatría, Ayuntamiento de Málaga. Presidencia de la Sociedad Española de Geriatría y Gerontología (SEGG), Málaga, España.
| | | | - Alberto Mariano Lázaro
- Medicina Preventiva y Salud Pública, Unidad de Epidemiología, Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, España
| | - Gloria Mato Chaín
- Medicina Preventiva y Salud Pública, Unidad de Vacunación del Adulto, Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, España
| | | | - Primitivo Ramos Cordero
- Coordinación médico-asistencial, Servicio Regional de Bienestar Social, Comunidad de Madrid, Madrid, España
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Yang KC, Hung HF, Chen MK, Chen SLS, Fann JCY, Chiu SYH, Yen AMF, Huang KC, Chen HH, Wang ST. Cost-effectiveness analysis of universal influenza vaccination: Application of the susceptible-infectious-complication-recovery model. Int J Infect Dis 2018; 73:102-108. [PMID: 29906602 DOI: 10.1016/j.ijid.2018.05.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 05/24/2018] [Accepted: 05/29/2018] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVES Despite the fact that vaccination is an effective primary prevention strategy for the containment of influenza outbreaks, health policymakers have shown great concern over the enormous costs involved in universal immunization, particularly when resources are limited. METHODS A two-arm cost-effectiveness analysis (CEA) was conducted that took into account the aspect of herd immunity. The analysis used a study cohort of 100000 residents with a demographic make-up identical to that of the underlying population in Taipei County, Taiwan, during the epidemic influenza season of 2001-2002. The parameters embedded in the dynamic process of infection were estimated through the application of the newly proposed susceptible-infection-complication-recovery (SICR) model to the empirical data, in order to compute the number of deaths and complications averted due to universal vaccination compared to no vaccination. Incremental cost-effectiveness ratios (ICERs) and the cost-effectiveness acceptability curve (CEAC) given maximum amount of willingness-to-pay (WTP) were calculated to delineate the results of the two-arm CEA. RESULTS The incremental costs involved in the vaccinated group as compared to the unvaccinated group were $1195 to reduce one additional complication and $805 to avert one additional death, allowing for herd immunity. The corresponding figures were higher for the results without considering herd immunity. Given the ceiling ratio of WTP equal to $10000 (approximately two-thirds of GDP), the probability of the vaccination being cost-effective for averting death was 100% and for averting complications was 96.7%. CONCLUSIONS Universal vaccination against seasonal influenza was found to be very cost-effective, particularly when herd immunity is considered. The probability of being cost-effective was almost certain given the maximum amount of WTP within two-thirds of the GDP.
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Affiliation(s)
- Kuen-Cheh Yang
- Department of Family Medicine, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan
| | - Hui-Fang Hung
- Department of Community and Family Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Meng-Kan Chen
- Department of Community and Family Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jean Ching-Yuan Fann
- Department of Health Industry Management, School of Healthcare Management, Kainan University, Tao-Yuan, Taiwan
| | - Sherry Yueh-Hsia Chiu
- Department of Health Care Management, College of Management, Chang Gung University, Tao-Yuan, Taiwan; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kuo-Chin Huang
- Department of Family Medicine, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan; Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Sen-Te Wang
- Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan; School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan.
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20
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Boccalini S, Bechini A, Innocenti M, Sartor G, Manzi F, Bonanni P, Panatto D, Lai PL, Zangrillo F, Rizzitelli E, Iovine M, Amicizia D, Bini C, Marcellusi A, Mennini FS, Rinaldi A, Trippi F, Ferriero AM, Lisi GC. [The universal influenza vaccination in children with Vaxigrip Tetra ® in Italy: an evaluation of Health Technology Assessment]. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2018; 59:E1-E86. [PMID: 30465031 PMCID: PMC6219245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Sara Boccalini
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - Angela Bechini
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | | | - Gino Sartor
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - Federico Manzi
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - Paolo Bonanni
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - Donatella Panatto
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - Piero Luigi Lai
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | | | | | | | - Daniela Amicizia
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - Chiara Bini
- Economic Evaluation and HTA (CEIS- EEHTA) - Facoltà di Economia, Università Tor Vergata
| | - Andrea Marcellusi
- Economic Evaluation and HTA (CEIS- EEHTA) - Facoltà di Economia, Università Tor Vergata
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21
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Stable incorporation of GM-CSF into dissolvable microneedle patch improves skin vaccination against influenza. J Control Release 2018; 276:1-16. [PMID: 29496540 PMCID: PMC5967648 DOI: 10.1016/j.jconrel.2018.02.033] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/17/2018] [Accepted: 02/19/2018] [Indexed: 11/20/2022]
Abstract
The widely used influenza subunit vaccine would benefit from increased protection rates in vulnerable populations. Skin immunization by microneedle (MN) patch can increase vaccine immunogenicity, as well as increase vaccination coverage due to simplified administration. To further increase immunogenicity, we used granulocyte-macrophage colony stimulating factor (GM-CSF), an immunomodulatory cytokine already approved for skin cancer therapy and cancer support treatment. GM-CSF has been shown to be upregulated in skin following MN insertion. The GM-CSF-adjuvanted vaccine induced robust and long-lived antibody responses cross-reactive to homosubtypic and heterosubtypic influenza viruses. Addition of GM-CSF resulted in increased memory B cell persistence relative to groups given influenza vaccine alone and led to rapid lung viral clearance following lethal infection with homologous virus in the mouse model. Here we demonstrate that successful incorporation of the thermolabile cytokine GM-CSF into MN resulted in improved vaccine-induced protective immunity holding promise as a novel approach to improved influenza vaccination. To our knowledge, this is the first successful incorporation of a cytokine adjuvant into dissolvable MNs, thus advancing and diversifying the rapidly developing field of MN vaccination technology.
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Hart RJ, Stevenson MD, Smith MJ, LaJoie AS, Cross K. Cost-effectiveness of Strategies for Offering Influenza Vaccine in the Pediatric Emergency Department. JAMA Pediatr 2018; 172:e173879. [PMID: 29114729 PMCID: PMC6583269 DOI: 10.1001/jamapediatrics.2017.3879] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Influenza is a significant public health burden, causing morbidity and mortality in children, yet vaccination rates remain low. Vaccination in the pediatric emergency department (PED) setting may be beneficial but, to date, has not been proven to be cost-effective. OBJECTIVE To compare the cost-effectiveness of 4 strategies for PED-based influenza vaccine: offering vaccine to all patients, only to patients younger than 5 years, only to high-risk patients (all ages), or to no patients. DESIGN, SETTING, AND PARTICIPANTS Using commercial decision analysis software, a cost-effectiveness analysis was performed from January 1, 2016, to June 1, 2017, to compare influenza vaccine strategies at a tertiary, urban, freestanding PED with an estimated 60 000 visits per year among a hypothetical cohort of children visiting the above PED during influenza season. Sensitivity analyses estimated the effect of uncertainties across a variety of input variables (eg, influenza prevalence, vaccine price and effectiveness, and costs of complications). MAIN OUTCOMES AND MEASURES The primary outcomes were cost and incremental cost-effectiveness ratio in dollars per influenza case averted. Secondary outcomes included total societal costs, hospitalizations and deaths averted, and quality-adjusted life-years gained. RESULTS Offering influenza vaccine to all eligible patients has the lowest cost, at $114.45 (95% CI, $55.48-$245.45) per case of influenza averted. This strategy saves $33.51 (95% CI, $18-$62) per case averted compared with no vaccination, and averages 27 fewer cases of influenza per 1000 patients. Offering vaccine to all patients resulted in 0.72 days (95% CI, 0.18-1.78 days) of quality-adjusted life-years lost, whereas offering to none resulted in 0.91 days (95% CI, 0.25-2.2 days) of quality-adjusted life-years lost. In sensitivity analyses, this strategy remains robustly cost-effective across a wide range of assumptions. In addition to being the most cost-effective strategy regardless of age or risk status, routine vaccination in the PED results in a net societal monetary benefit under many circumstances. In Monte Carlo analysis, offering vaccine to all patients was superior to other strategies in at least 99.8% of cases. CONCLUSIONS AND RELEVANCE Although few PEDs routinely offer influenza vaccination, doing so appears to be cost-effective, with the potential to significantly reduce the economic (and patient) burden of pediatric influenza.
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Affiliation(s)
- Rebecca J. Hart
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - Michelle D. Stevenson
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - Michael J. Smith
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - A. Scott LaJoie
- Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky
| | - Keith Cross
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville, Louisville, Kentucky
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Tsuzuki S, Schwehm M, Eichner M. Simulation studies to assess the long-term effects of Japan's change from trivalent to quadrivalent influenza vaccination. Vaccine 2017; 36:624-630. [PMID: 29292176 DOI: 10.1016/j.vaccine.2017.12.058] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Since 2013/2014, the WHO has been recommending quadrivalent influenza vaccines (QIV) to prevent seasonal influenza. In 2015, Japan replaced trivalent influenza vaccines (TIV) by QIV. We used computer simulations to calculate how this impacted the epidemiology and to assess its cost-effectiveness. METHODS We simulated the seasonal transmission of the four influenza strains A(H1N1), A(H3N2), B/Yamagata and B/Victoria with the individual-based simulation tool 4Flu, using official demographic data and Japanese contact patterns. The model considered maternal protection, immunity boosting, new drift variants and different immunity durations for naturally acquired and vaccination-derived immunity. Starting with the 2015/16 season, simulations were evaluated for 20 years, using either TIV or QIV with the reported vaccination coverage. Costs and years of life saved (YOLSs) were calculated and discounted at 2%, using 2015 as base year. RESULTS QIV annually prevents on average 548 influenza cases (4.7% of cases which occur when using TIV; 11.9% of influenza B), 1.62 hospitalizations and 0.078 deaths per 100,000 individuals. In Japan's population of 125.35 million, annually 915.06 YOLYs are gained by QIV and 107.52 million USD are saved (societal perspective) [corrected]. From payer perspective, the ICER is 3698 USD/YOLS. CONCLUSIONS QIV is cost-effective (payer perspective) or even cost-saving (societal perspective) in Japan.
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Affiliation(s)
- Shinya Tsuzuki
- Department of Hygiene, Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan.
| | | | - Martin Eichner
- Department for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany; Epimos GmbH, Dußlingen, Germany
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Gresset-Bourgeois V, Leventhal PS, Pepin S, Hollingsworth R, Kazek-Duret MP, De Bruijn I, Samson SI. Quadrivalent inactivated influenza vaccine (VaxigripTetra™). Expert Rev Vaccines 2017; 17:1-11. [PMID: 29157068 DOI: 10.1080/14760584.2018.1407650] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION VaxigripTetra™ (IIV4; Sanofi Pasteur) is a quadrivalent split-virion influenza vaccine approved in Europe in 2016 for individuals ≥ 3 years of age. IIV4 builds on the well-established record of the trivalent split-virion influenza vaccine (Vaxigrip®). Areas covered: This literature review summarizes the rationale for developing quadrivalent influenza vaccines and discusses the phase III clinical trial results supporting the immunogenicity, safety, and tolerability of IIV4. Expert commentary: IIV4 is immunogenic and well tolerated. Adding a second B strain to the trivalent split-virion influenza vaccine provides a superior immune response for the additional strain but does not reduce the immune response for the three other strains or negatively affect the safety profile. By offering broader protection against co-circulating influenza B lineages, IIV4 has the potential to further reduce influenza-related morbidity and mortality beyond that achieved with trivalent vaccines.
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Affiliation(s)
| | | | - Stéphanie Pepin
- c Clinical Development , Sanofi Pasteur , Marcy l'Étoile , France
| | | | | | - Iris De Bruijn
- c Clinical Development , Sanofi Pasteur , Marcy l'Étoile , France
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25
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Woolthuis RG, Wallinga J, van Boven M. Variation in loss of immunity shapes influenza epidemics and the impact of vaccination. BMC Infect Dis 2017; 17:632. [PMID: 28927373 PMCID: PMC5606000 DOI: 10.1186/s12879-017-2716-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 09/05/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Protective antibody immunity against the influenza A virus wanes in 2-7 years due to antigenic drift of the virus' surface proteins. The duration of immune protection is highly variable because antigenic evolution of the virus is irregular. Currently, the variable nature of the duration of immunity has had little attention in analyses of the impact of vaccination, including cost-effectiveness studies. METHODS We developed a range of mathematical transmission models to investigate the effect of variable duration of immunity on the size of seasonal epidemics. The models range from simple conceptual to more realistic, by distinguishing between infection- versus vaccination-induced immunity, by inclusion of primary vaccine failure, by assuming a leaky vaccine, and by the inclusion of age-dependent contact patterns. RESULTS We show that annual variation in the duration of immunity causes large variation in the size of epidemics, and affects the effectiveness of vaccination. Accumulation of susceptible individuals in one or more mild seasons results in a disproportionately large outbreak in a subsequent season. Importantly, variation in the duration of immunity increases the average infection attack rate when the vaccination coverage is around the outbreak threshold. Specifically, in a tailored age-stratified model with a realistic reproduction number (R 0 = 1.4) and vaccination coverage of 25%, we find that the attack rate in unvaccinated children (<10 years old) is negligible if the duration of immunity is constant, while on average 2.8% (2.5-97.5% percentiles: 1.8-4.1%) of the children are infected if the duration of immunity is variable. These findings stem from the buildup of susceptibility over multiple seasons by waning of immunity, and the nonlinear relation between susceptibility and infection attack rates. CONCLUSIONS The models illustrate that variation in the duration of immunity impacts the long-term effectiveness of vaccination, and that vaccine effectiveness cannot be judged for each year in isolation. Our findings have implications for vaccination strategies that aim to maximize the vaccination coverage while extending the age range of persons eligible for vaccination.
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Affiliation(s)
- Rutger G Woolthuis
- Theoretical Biology, Utrecht University, Padualaan 8, Utrecht, 3584 CH, The Netherlands. .,National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, The Netherlands.
| | - Jacco Wallinga
- National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, The Netherlands
| | - Michiel van Boven
- National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, The Netherlands
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de Boer PT, van Maanen BM, Damm O, Ultsch B, Dolk FCK, Crépey P, Pitman R, Wilschut JC, Postma MJ. A systematic review of the health economic consequences of quadrivalent influenza vaccination. Expert Rev Pharmacoecon Outcomes Res 2017; 17:249-265. [PMID: 28613092 DOI: 10.1080/14737167.2017.1343145] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Quadrivalent influenza vaccines (QIVs) contain antigens derived from an additional influenza type B virus as compared with currently used trivalent influenza vaccines (TIVs). This should overcome a potential reduced vaccine protection due to mismatches between TIV and circulating B viruses. In this study, we systematically reviewed the available literature on health economic evaluations of switching from TIV to QIV. Areas covered: The databases of Medline and Embase were searched systematically to identify health economic evaluations of QIV versus TIV published before September 2016.A total of sixteen studies were included, thirteen cost-effectiveness analyses and three cost-comparisons. Expert commentary: Published evidence on the cost-effectiveness of QIV suggests that switching from TIV to QIV would be a valuable intervention from both the public health and economic viewpoint. However, more research seems mandatory. Our main recommendations for future research include: 1) more extensive use of dynamic models in order to estimate the full impact of QIV on influenza transmission including indirect effects, 2) improved availability of data on disease outcomes and costs related to influenza type B viruses, and 3) more research on immunogenicity of natural influenza infection and vaccination, with emphasis on cross-reactivity between different influenza B viruses and duration of protection.
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Affiliation(s)
- Pieter T de Boer
- a Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE2), Groningen Research Institute of Pharmacy , University of Groningen , Groningen , The Netherlands
| | - Britt M van Maanen
- a Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE2), Groningen Research Institute of Pharmacy , University of Groningen , Groningen , The Netherlands
| | - Oliver Damm
- b Department of Health Economics and Health Care Management, School of Public Health , Bielefeld University , Bielefeld , Germany
| | - Bernhard Ultsch
- c Immunisation Unit , Robert Koch Institute , Berlin , Germany
| | - Franklin C K Dolk
- a Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE2), Groningen Research Institute of Pharmacy , University of Groningen , Groningen , The Netherlands
| | - Pascal Crépey
- d Department of Quantitative Methods in Public Health , EHESP Rennes , Sorbonne Paris Cité, Rennes , France.,e UPRES-EA-7449 Reperes, University of Rennes 1 , Rennes , France
| | | | - Jan C Wilschut
- g Department of Medical Microbiology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Maarten J Postma
- a Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE2), Groningen Research Institute of Pharmacy , University of Groningen , Groningen , The Netherlands.,h Department of Epidemiology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.,i Institute of Science in Healthy Aging & healthcaRE (SHARE) , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
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Ray R, Dos Santos G, Buck PO, Claeys C, Matias G, Innis BL, Bekkat-Berkani R. A review of the value of quadrivalent influenza vaccines and their potential contribution to influenza control. Hum Vaccin Immunother 2017; 13:1640-1652. [PMID: 28532276 PMCID: PMC5512791 DOI: 10.1080/21645515.2017.1313375] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The contribution of influenza B to the seasonal influenza burden varies from year-to-year. Although 2 antigenically distinct influenza B virus lineages have co-circulated since 2001, trivalent influenza vaccines (TIVs) contain antigens from only one influenza B virus. B-mismatch or co-circulation of both B lineages results in increased morbidity and mortality attributable to the B lineage absent from the vaccine. Quadrivalent vaccines (QIVs) contain both influenza B lineages. We reviewed currently licensed QIVs and their value by focusing on the preventable disease burden. Modeling studies support that QIVs are expected to prevent more influenza cases, hospitalisations and deaths than TIVs, although estimates of the case numbers prevented vary according to local specificities. The value of QIVs is demonstrated by their capacity to broaden the immune response and reduce the likelihood of a B-mismatched season. Some health authorities have preferentially recommended QIVs over TIVs in their influenza prevention programmes.
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Affiliation(s)
| | - Gaël Dos Santos
- b Business & Decision Life Sciences , Brussels , Belgium (on behalf of GSK)
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Jamotte A, Clay E, Macabeo B, Caicedo A, Lopez JG, Bricks L, Romero Prada M, Marrugo R, Alfonso P, Moreno Arévalo B, Franco D, Garcia Diaz L, Isaza de Molto Y. Public health impact and economic benefits of quadrivalent influenza vaccine in Latin America. Hum Vaccin Immunother 2017; 13:877-888. [PMID: 28118092 PMCID: PMC5404619 DOI: 10.1080/21645515.2016.1256928] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Annual trivalent influenza vaccines (TIV) containing 2 A strains and one B lineage have been recommended for the prevention of influenza in most of Latin American countries. However, the circulation of 2 B lineages (Victoria and Yamagata) and difficulties in predicting the predominating lineage have led to the development of quadrivalent influenza vaccines (QIV), including both B lineages. Thus, the objective was to estimate the public health impact and influenza-related costs if QIV would have been used instead of TIV in 3 Latin American countries. We used a static model over the seasons 2010–2014 in Brazil, 2007–2014 in Colombia and 2006–2014 in Panama, focusing on population groups targeted by local vaccination recommendations: young children, adults with risk factors and the elderly. In Brazil, between 2010 and 2014, using QIV instead of TIV would have avoided US$ 6,200 per 100,000 person-years in societal costs, based on 168 influenza cases, 89 consultations, 3.2 hospitalizations and 0.38 deaths per 100,000 person-years. In Colombia and Panama, these would have ranged from US$ 1,000 to 12,700 (based on 34 cases, 13–25 consultations, 0.6–8.9 hospitalizations and 0.04–1.74 deaths) and from US$ 3,000 to 33,700 (based on 113 cases, 55–82 consultations, 0.5–27.8 hospitalizations and 0.08–6.87 deaths) per 100,000 person-years, respectively. Overall, the broader protection offered by QIV would have reduced the influenza humanistic and economic burden in the 3 countries. Despite the lack of local data leading to several extrapolations, this study is the first to give quantitative estimates of the potential benefits of QIV in Latin America.
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Affiliation(s)
| | | | | | | | | | - Lucia Bricks
- e Sanofi Pasteur Latin America , Sao Paulo , Brazil
| | | | | | | | | | - Danilo Franco
- g The Gorgas Memorial Institute for Health Studies , Panama City , Panama
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Dolk C, Eichner M, Welte R, Anastassopoulou A, Van Bellinghen LA, Poulsen Nautrup B, Van Vlaenderen I, Schmidt-Ott R, Schwehm M, Postma M. Cost-Utility of Quadrivalent Versus Trivalent Influenza Vaccine in Germany, Using an Individual-Based Dynamic Transmission Model. PHARMACOECONOMICS 2016; 34:1299-1308. [PMID: 27647004 PMCID: PMC5110585 DOI: 10.1007/s40273-016-0443-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND Seasonal influenza infection is primarily caused by circulation of two influenza A strain subtypes and strains from two B lineages that vary each year. Trivalent influenza vaccine (TIV) contains only one of the two B-lineage strains, resulting in mismatches between vaccine strains and the predominant circulating B lineage. Quadrivalent influenza vaccine (QIV) includes both B-lineage strains. The objective was to estimate the cost-utility of introducing QIV to replace TIV in Germany. METHODS An individual-based dynamic transmission model (4Flu) using German data was used to provide realistic estimates of the impact of TIV and QIV on age-specific influenza infections. Cases were linked to health and economic outcomes to calculate the cost-utility of QIV versus TIV, from both a societal and payer perspective. Costs and effects were discounted at 3.0 and 1.5 % respectively, with 2014 as the base year. Univariate and probabilistic sensitivity analyses were conducted. RESULTS Using QIV instead of TIV resulted in additional quality-adjusted life-years (QALYs) and cost savings from the societal perspective (i.e. it represents the dominant strategy) and an incremental cost-utility ratio (ICUR) of €14,461 per QALY from a healthcare payer perspective. In all univariate analyses, QIV remained cost-effective (ICUR <€50,000). In probabilistic sensitivity analyses, QIV was cost-effective in >98 and >99 % of the simulations from the societal and payer perspective, respectively. CONCLUSION This analysis suggests that QIV in Germany would provide additional health gains while being cost-saving to society or costing €14,461 per QALY gained from the healthcare payer perspective, compared with TIV.
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Affiliation(s)
- Christiaan Dolk
- PharmacoEpidemiology and PharmacoEconomics, University of Groningen, Antonius Deusinglaan 1, 9713 GZ, Groningen, The Netherlands.
| | - Martin Eichner
- Epimos GmbH, Uhlandstrasse 3, 72144, Dusslingen, Germany
- Clinical Epidemiology and Applied Biometry, Tübingen University, Silcherstrasse 5, 72076, Tübingen, Germany
| | - Robert Welte
- GSK Germany, Prinzregentenplatz 9, 81675, München, Germany
| | | | | | | | | | - Ruprecht Schmidt-Ott
- GSK Germany, Prinzregentenplatz 9, 81675, München, Germany
- GSK Vaccines, Avenue Fleming 20, 1300, Wavre, Belgium
| | - Markus Schwehm
- ExploSYS GmbH, Otto-Hahn-Weg 6, 70771, Leinfelden-Echterdingen, Germany
| | - Maarten Postma
- PharmacoEpidemiology and PharmacoEconomics, University of Groningen, Antonius Deusinglaan 1, 9713 GZ, Groningen, The Netherlands
- Institute for Science in Healthy Aging and healthcaRE (SHARE), University Medical Center Groningen (UMCG), Hanzeplein 1, Groningen, 9713 GZ, The Netherlands
- Department of Epidemiology, University Medical Center Groningen (UMCG), Hanzeplein 1, Groningen, 9713 GZ, The Netherlands
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de Boer PT, Crépey P, Pitman RJ, Macabeo B, Chit A, Postma MJ. Cost-Effectiveness of Quadrivalent versus Trivalent Influenza Vaccine in the United States. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:964-975. [PMID: 27987647 DOI: 10.1016/j.jval.2016.05.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 05/17/2016] [Accepted: 05/18/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Designed to overcome influenza B mismatch, new quadrivalent influenza vaccines (QIVs) contain one additional B strain compared with trivalent influenza vaccines (TIVs). OBJECTIVE To examine the expected public health impact, budget impact, and incremental cost-effectiveness of QIV versus TIV in the United States. METHODS A dynamic transmission model was used to predict the annual incidence of influenza over the 20-year-period of 2014 to 2034 under either a TIV program or a QIV program. A decision tree model was interfaced with the transmission model to estimate the public health impact and the cost-effectiveness of replacing TIV with QIV from a societal perspective. Our models were informed by published data from the United States on influenza complication probabilities and relevant costs. The incremental vaccine price of QIV as compared with that of TIV was set at US $5.40 per dose. RESULTS Over the next 20 years, replacing TIV with QIV may reduce the number of influenza B cases by 27.2% (16.0 million cases), resulting in the prevention of 137,600 hospitalizations and 16,100 deaths and a gain of 212,000 quality-adjusted life-years (QALYs). The net societal budget impact would be US $5.8 billion and the incremental cost-effectiveness ratio US $27,411/QALY gained. In the probabilistic sensitivity analysis, 100% and 96.5% of the simulations fell below US $100,000/QALY and US $50,000/QALY, respectively. CONCLUSIONS Introducing QIV into the US immunization program may prevent a substantial number of hospitalizations and deaths. QIV is also expected to be a cost-effective alternative option to TIV.
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Affiliation(s)
- Pieter T de Boer
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
| | - Pascal Crépey
- EHESP Rennes, Sorbonne Paris-Cité, Paris, France; Aix-Marseille Univ, UMR EPV 190, Marseille, France
| | | | | | - Ayman Chit
- Sanofi Pasteur, Swiftwater, PA, USA; Lesli Dan Faculty of Pharmacy, Toronto, Ontario, Canada
| | - Maarten J Postma
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands; Institute of Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen (UMCG), Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
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Brogan AJ, Talbird SE, Davis AE, Thommes EW, Meier G. Cost-effectiveness of seasonal quadrivalent versus trivalent influenza vaccination in the United States: A dynamic transmission modeling approach. Hum Vaccin Immunother 2016; 13:533-542. [PMID: 27780425 PMCID: PMC5360116 DOI: 10.1080/21645515.2016.1242541] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Trivalent inactivated influenza vaccines (IIV3s) protect against 2 A strains and one B lineage; quadrivalent versions (IIV4s) protect against an additional B lineage. The objective was to assess projected health and economic outcomes associated with IIV4 versus IIV3 for preventing seasonal influenza in the US. A cost-effectiveness model was developed to interact with a dynamic transmission model. The transmission model tracked vaccination, influenza cases, infection-spreading interactions, and recovery over 10 y (2012–2022). The cost-effectiveness model estimated influenza-related complications, direct and indirect costs (2013–2014 US$), health outcomes, and cost-effectiveness. Inputs were taken from published/public sources or estimated using regression or calibration. Outcomes were discounted at 3% per year. Scenario analyses tested the reliability of the results. Seasonal vaccination with IIV4 versus IIV3 is predicted to reduce annual influenza cases by 1,973,849 (discounted; 2,325,644 undiscounted), resulting in 12–13% fewer cases and influenza-related complications and deaths. These reductions are predicted to translate into 18,485 more quality-adjusted life years (QALYs) accrued annually for IIV4 versus IIV3. Increased vaccine-related costs ($599 million; 5.7%) are predicted to be more than offset by reduced influenza treatment costs ($699 million; 12.2%), resulting in direct medical cost saving annually ($100 million; 0.6%). Including indirect costs, savings with IIV4 are predicted to be $7.1 billion (5.6%). Scenario analyses predict IIV4 to be cost-saving in all scenarios tested apart from low infectivity, where IIV4 is predicted to be cost-effective. In summary, seasonal influenza vaccination in the US with IIV4 versus IIV3 is predicted to improve health outcomes and reduce costs.
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Affiliation(s)
- Anita J Brogan
- a RTI Health Solutions , Research Triangle Park , NC , USA
| | | | - Ashley E Davis
- a RTI Health Solutions , Research Triangle Park , NC , USA
| | - Edward W Thommes
- b Medical Division, GSK Inc , Mississauga , ON , Canada.,c University of Guelph , Guelph , ON , Canada
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Yang MC, Tan ECH, Su JJ. Cost-effectiveness analysis of quadrivalent versus trivalent influenza vaccine in Taiwan: A lifetime multi-cohort model. Hum Vaccin Immunother 2016; 13:81-89. [PMID: 27624648 DOI: 10.1080/21645515.2016.1225636] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
A government-funded trivalent influenza vaccine (TIV) program to prevent seasonal influenza was implemented in Taiwan since 1998. However, mismatch between the vaccine and circulating strains may occur. Alternatively, a quadrivalent influenza vaccine (QIV) includes all 4 influenza lineages could minimize the risk of mismatches. Therefore, QIV could be considered as an alternative strategy to enhance protection against seasonal influenza. The objective of the study was to analyze, from a governmental perspective, the cost-effectiveness of using QIV vs. TIV as a vaccination strategy in Taiwan. A lifetime multi-cohort, static Markov model was constructed with 9 age groups to assess the costs and effectiveness of QIV vs. TIV. Direct costs were obtained from a database released by the Ministry of Health and Welfare. Outcomes included life-years gained, quality-adjusted life years (QALYs) gained, influenza cases avoided and incremental cost-effectiveness ratios (ICERs). The discount rate of costs and effectiveness was set at 3.5% and the time horizon used in the model was 100 y. Results show that a vaccination strategy utilizing QIV instead of TIV would bring an additional 10,557 QALYs at an extra cost of US$39.4 million, yielding an ICER of US$3,015.07 per QALY gained. When setting the willingness-to-pay threshold at US$10,000, compared to TIV, the probability that QIV would be cost-effective was 98%. Sensitivity analyses show that ICER was sensitive to the changes of circulation of influenza virus subtypes and vaccine mismatch. From a governmental perspective, the QIV vaccination could be considered as a cost-effective strategy within the context of public health in Taiwan.
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Affiliation(s)
- Ming-Chin Yang
- a Institute of Health Policy and Management, College of Public Health, National Taiwan University , Taipei , Taiwan
| | - Elise Chia-Hui Tan
- a Institute of Health Policy and Management, College of Public Health, National Taiwan University , Taipei , Taiwan
| | - Jian-Jhih Su
- b Medical Affairs Division, National Health Insurance Administration , Taipei , Taiwan
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Cost Effectiveness of Influenza Vaccine for U.S. Children: Live Attenuated and Inactivated Influenza Vaccine. Am J Prev Med 2016; 51:309-17. [PMID: 27079638 PMCID: PMC5384696 DOI: 10.1016/j.amepre.2016.02.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 02/02/2016] [Accepted: 02/16/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Prior studies showed that live attenuated influenza vaccine (LAIV) is more effective than inactivated influenza vaccine (IIV) in children aged 2-8 years, supporting the Centers for Disease Control and Prevention (CDC) recommendations in 2014 for preferential LAIV use in this age group. However, 2014-2015 U.S. effectiveness data indicated relatively poor effectiveness of both vaccines, leading CDC in 2015 to no longer prefer LAIV. METHODS An age-structured model of influenza transmission and vaccination was developed, which incorporated both direct and indirect protection induced by vaccination. Based on this model, the cost effectiveness of influenza vaccination strategies in children aged 2-8 years in the U.S. was estimated. The base case assumed a mixed vaccination strategy where 33.3% and 66.7% of vaccinated children aged 2-8 years receive LAIV and IIV, respectively. Analyses were performed in 2014-2015. RESULTS Using published meta-analysis vaccine effectiveness data (83% LAIV and 64% IIV), exclusive LAIV use would be a cost-effective strategy when vaccinating children aged 2-8 years, whereas IIV would not be preferred. However, when 2014-2015 U.S. effectiveness data (0% LAIV and 15% IIV) were used, IIV was likely to be preferred. CONCLUSIONS The cost effectiveness of influenza vaccination in children aged 2-8 years is highly dependent on vaccine effectiveness; the vaccine type with higher effectiveness is preferred. In general, exclusive IIV use is preferred over LAIV use, as long as vaccine effectiveness is higher for IIV than for LAIV.
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Nagy L, Heikkinen T, Sackeyfio A, Pitman R. The Clinical Impact and Cost Effectiveness of Quadrivalent Versus Trivalent Influenza Vaccination in Finland. PHARMACOECONOMICS 2016; 34:939-51. [PMID: 27423657 PMCID: PMC4980401 DOI: 10.1007/s40273-016-0430-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND Trivalent influenza vaccines encompass one influenza B lineage; however, predictions have been unreliable on which of two antigenically distinct circulating lineages will dominate. Quadrivalent seasonal influenza vaccines contain strains from both lineages. This analysis assesses the cost effectiveness of switching from trivalent inactivated influenza vaccination (TIV) in Finland to quadrivalent vaccination, using inactivated (QIV) or live-attenuated (Q-LAIV) vaccines. METHODS A transmission model simulated the dynamics of influenza infection while accounting for indirect (herd) protection. Prior distributions for key transmission parameters were repeatedly sampled and simulations that fitted the available information on influenza in Finland were recorded. The resulting posterior parameter distributions were used in a probabilistic sensitivity analysis in which economic parameters were sampled, simultaneously encompassing uncertainty in the transmission and economic parameters. The cost effectiveness of a range of trivalent and quadrivalent vaccine policies over a 20-year time horizon was assessed from both a societal and payer perspective in 2014 Euros. RESULTS The simulated temporal incidence pattern of symptomatic infections corresponded well with case surveillance data. A switch from the current TIV to Q-LAIV in children (2 to <18 years) and to QIV in other ages was estimated to annually avert approximately 76,100 symptomatic infections (95 % range 36,700-146,700), 11,500 primary care consultations (6100-20,000), 540 hospitalisations (240-1180), and 72 deaths (32-160), and was cost-saving relative to TIV (€374 million averted [€161-€752], in 2014 Euros, discounted at 3 %). This scenario had the highest probability of being the most cost-effective scenario considered. CONCLUSIONS This analysis demonstrates that quadrivalent vaccination is expected to be highly cost effective, reducing the burden of influenza-related disease.
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MESH Headings
- Adolescent
- Child
- Child, Preschool
- Cost-Benefit Analysis
- Finland
- Hospitalization/economics
- Humans
- Immunity, Herd
- Influenza Vaccines/administration & dosage
- Influenza Vaccines/economics
- Influenza, Human/economics
- Influenza, Human/prevention & control
- Influenza, Human/virology
- Models, Economic
- Vaccination/economics
- Vaccination/methods
- Vaccines, Attenuated/administration & dosage
- Vaccines, Attenuated/economics
- Vaccines, Inactivated/administration & dosage
- Vaccines, Inactivated/economics
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Affiliation(s)
- Lisa Nagy
- ICON Health Economics and Epidemiology, 100 Park Drive, Milton Park, Oxfordshire, OX14 4RY, Oxford, UK.
| | - Terho Heikkinen
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | | | - Richard Pitman
- ICON Health Economics and Epidemiology, 100 Park Drive, Milton Park, Oxfordshire, OX14 4RY, Oxford, UK
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de Boer PT, Frederix GWJ, Feenstra TL, Vemer P. Unremarked or Unperformed? Systematic Review on Reporting of Validation Efforts of Health Economic Decision Models in Seasonal Influenza and Early Breast Cancer. PHARMACOECONOMICS 2016; 34:833-845. [PMID: 27129572 PMCID: PMC4980411 DOI: 10.1007/s40273-016-0410-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Transparent reporting of validation efforts of health economic models give stakeholders better insight into the credibility of model outcomes. In this study we reviewed recently published studies on seasonal influenza and early breast cancer in order to gain insight into the reporting of model validation efforts in the overall health economic literature. METHODS A literature search was performed in Pubmed and Embase to retrieve health economic modelling studies published between 2008 and 2014. Reporting on model validation was evaluated by checking for the word validation, and by using AdViSHE (Assessment of the Validation Status of Health Economic decision models), a tool containing a structured list of relevant items for validation. Additionally, we contacted corresponding authors to ask whether more validation efforts were performed other than those reported in the manuscripts. RESULTS A total of 53 studies on seasonal influenza and 41 studies on early breast cancer were included in our review. The word validation was used in 16 studies (30 %) on seasonal influenza and 23 studies (56 %) on early breast cancer; however, in a minority of studies, this referred to a model validation technique. Fifty-seven percent of seasonal influenza studies and 71 % of early breast cancer studies reported one or more validation techniques. Cross-validation of study outcomes was found most often. A limited number of studies reported on model validation efforts, although good examples were identified. Author comments indicated that more validation techniques were performed than those reported in the manuscripts. CONCLUSIONS Although validation is deemed important by many researchers, this is not reflected in the reporting habits of health economic modelling studies. Systematic reporting of validation efforts would be desirable to further enhance decision makers' confidence in health economic models and their outcomes.
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Affiliation(s)
- Pieter T de Boer
- Department of Pharmacy, PharmacoTherapy, -Epidemiology and -Economics (PTEE), University of Groningen, Groningen, The Netherlands
| | - Geert W J Frederix
- Pharmacoepidemiology and Clinical Pharmacology, University of Utrecht, Utrecht, The Netherlands
| | - Talitha L Feenstra
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
- Centre for Nutrition, Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Pepijn Vemer
- Department of Pharmacy, PharmacoTherapy, -Epidemiology and -Economics (PTEE), University of Groningen, Groningen, The Netherlands.
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
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Van Maanen BM, de Boer PT, Dolk FCK, Friedrich AW, Wilschut JC, Pitman R, Postma MJ. Dynamic modelling approaches for the analysis of the cost-effectiveness of seasonal influenza control. Expert Rev Vaccines 2016; 16:1-4. [DOI: 10.1080/14760584.2016.1221347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- B. M. Van Maanen
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - P. T. de Boer
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - F. C. K. Dolk
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - A. W. Friedrich
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J. C. Wilschut
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R. Pitman
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- ICON Health Economics and Epidemiology, Oxfordshire, UK
| | - M. J. Postma
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
- Institute of Science in Healthy Aging & healthcaRE (SHARE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Robertson CA, Tsang P, Landolfi VA, Greenberg DP. Fluzone® Intradermal Quadrivalent Influenza Vaccine. Expert Rev Vaccines 2016; 15:1245-53. [PMID: 27457797 DOI: 10.1080/14760584.2016.1215246] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION An intradermal version of Fluzone® split-virion inactivated trivalent influenza vaccine, containing 9 µg hemagglutinin per strain of A/H1N1, A/H3N2, and one B lineage virus (Fluzone Intradermal, Sanofi Pasteur), became available in the US during the 2011-2012 influenza season for adults 18-64 years of age. In advance of the 2015-2016 season, Fluzone Intradermal was replaced with Fluzone Intradermal Quadrivalent vaccine, which contains 9 µg hemagglutinin per strain of the two A-strain viruses and both B-strain lineage viruses (Victoria and Yamagata). AREAS COVERED This literature review summarizes the history and mechanism of intradermal vaccination, discusses the clinical trial results supporting the immunogenicity and safety of Fluzone Intradermal Quadrivalent vaccine, and describes the unique microinjection system used to deliver Fluzone Intradermal Quadrivalent. Expert commentary: Fluzone Intradermal Quadrivalent may boost confidence in influenza vaccination with the addition of a second B-lineage strain. By using an innovative microinjection system, the vaccine is also designed to address some of the logistic challenges faced by healthcare providers administering immunizations.
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Affiliation(s)
- Corwin A Robertson
- a Scientific and Medical Affairs Department , Sanofi Pasteur Inc ., Discovery Drive, Swiftwater , PA , USA
| | - Peter Tsang
- b Clinical Development Department , Sanofi Pasteur Inc ., Swiftwater , PA , USA
| | - Victoria A Landolfi
- c Late Development and Innovation Department , Sanofi Pasteur Inc ., Swiftwater , PA , USA
| | - David P Greenberg
- a Scientific and Medical Affairs Department , Sanofi Pasteur Inc ., Discovery Drive, Swiftwater , PA , USA.,d Department of Pediatrics , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
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Zhao Y, Zhang X, Zhu F, Jin H, Wang B. A preliminary cost-effectiveness analysis of hepatitis E vaccination among pregnant women in epidemic regions. Hum Vaccin Immunother 2016; 12:2003-2009. [PMID: 26900799 PMCID: PMC4994743 DOI: 10.1080/21645515.2016.1141844] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/27/2015] [Accepted: 01/10/2016] [Indexed: 12/19/2022] Open
Abstract
Objective To estimate the cost-effectiveness of hepatitis E vaccination among pregnant women in epidemic regions. Methods A decision tree model was constructed to evaluate the cost-effectiveness of 3 hepatitis E virus vaccination strategies from societal perspectives. The model parameters were estimated on the basis of published studies and experts' experience. Sensitivity analysis was used to evaluate the uncertainties of the model. Results Vaccination was more economically effective on the basis of the incremental cost-effectiveness ratio (ICER< 3 times China's per capital gross domestic product/quality-adjusted life years); moreover, screening and vaccination had higher QALYs and lower costs compared with universal vaccination. No parameters significantly impacted ICER in one-way sensitivity analysis, and probabilistic sensitivity analysis also showed screening and vaccination to be the dominant strategy. Conclusion Screening and vaccination is the most economical strategy for pregnant women in epidemic regions; however, further studies are necessary to confirm the efficacy and safety of the hepatitis E vaccines.
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Affiliation(s)
- Yueyuan Zhao
- School of Public Health, Southeast University, Nanjing, China
| | - Xuefeng Zhang
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Fengcai Zhu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Hui Jin
- School of Public Health, Southeast University, Nanjing, China
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Nanjing, China
| | - Bei Wang
- School of Public Health, Southeast University, Nanjing, China
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Nanjing, China
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Jamotte A, Chong CF, Manton A, Macabeo B, Toumi M. Impact of quadrivalent influenza vaccine on public health and influenza-related costs in Australia. BMC Public Health 2016; 16:630. [PMID: 27449665 PMCID: PMC4957923 DOI: 10.1186/s12889-016-3297-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/13/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Annual trivalent influenza vaccines (TIV) containing three influenza strains (A/H1N1, A/H3N2, and one B) have been recommended for the prevention of influenza. However, worldwide co-circulation of two distinct B lineages (Victoria and Yamagata) and difficulties in predicting which lineage will predominate each season have led to the development of quadrivalent influenza vaccines (QIV), which include both B lineages. Our analysis evaluates the public health benefit and associated influenza-related costs avoided which would have been obtained by using QIV rather than TIV in Australia over the period 2002-2012. METHODS A static model stratified by age group was used, focusing on people at increased risk of influenza as defined by the Australian vaccination recommendations. B-lineage cross-protection was accounted for. We calculated the potential impact of QIV compared with TIV over the seasons 2002-2012 (2009 pandemic year excluded) using Australian data on influenza circulation, vaccine coverage, hospitalisation and mortality rates as well as unit costs, and international data on vaccine effectiveness, influenza attack rate, GP consultation rate and working days lost. Third-party payer and societal influenza-related costs were estimated in 2014 Australian dollars. Sensitivity analyses were conducted. RESULTS Using QIV instead of TIV over the period 2002-2012 would have prevented an estimated 68,271 additional influenza cases, 47,537 GP consultations, 3,522 hospitalisations and 683 deaths in the population at risk of influenza. These results translate into influenza-related societal costs avoided of $46.5 million. The estimated impact of QIV was higher for young children and the elderly. The overall impact of QIV depended mainly on vaccine effectiveness and the influenza attack rate attributable to the mismatched B lineage. CONCLUSION The broader protection offered by QIV would have reduced the number of influenza infections and its related complications, leading to substantial influenza-related costs avoided.
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Affiliation(s)
- Aurélien Jamotte
- Creativ-Ceutical, 215 rue du Faubourg Saint Honoré, 75008, Paris, France.
| | - Chui Fung Chong
- Sanofi Pasteur Asia Pacific, 38 Beach Rd, #18-11, South Beach Tower, Singapore, 189767, Singapore.,Present Address: Takeda Development Center Asia, Pte. Ltd, 21 Biopolis Road, Nucleos North Tower, Level 4, Singapore, 138567, Singapore
| | - Andrew Manton
- Commercial Eyes, Level 11 500 Collins Street, Melbourne, VIC, 3000, Australia
| | | | - Mondher Toumi
- Creativ-Ceutical, 215 rue du Faubourg Saint Honoré, 75008, Paris, France.,Public Health Laboratory, Faculty of Medicine, Aix-Marseille University, 27 boulevard Jean Moulin, 13385, Marseille Cedex 05, France
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Moa AM, Chughtai AA, Muscatello DJ, Turner RM, MacIntyre CR. Immunogenicity and safety of inactivated quadrivalent influenza vaccine in adults: A systematic review and meta-analysis of randomised controlled trials. Vaccine 2016; 34:4092-4102. [PMID: 27381642 DOI: 10.1016/j.vaccine.2016.06.064] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 06/21/2016] [Accepted: 06/21/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND A quadrivalent influenza vaccine (QIV) includes two A strains (A/H1N1, A/H3N2) and two B lineages (B/Victoria, B/Yamagata). The presence of both B lineages eliminate potential B lineage mismatch of trivalent influenza vaccine (TIV) with the circulating strain. METHODS Electronic database searches of Medline, Embase, Cochrane Central Register of Controlled Trials (CCRCT), Scopus and Web of Science were conducted for articles published until June 30, 2015 inclusive. Articles were limited to randomised controlled trials (RCTs) in adults using inactivated intramuscular vaccine and published in English language only. Summary estimates of immunogenicity (by seroprotection and seroconversion rates) and adverse events outcomes were compared between QIV and TIV, using a risk ratio (RR). Studies were pooled using inverse variance weights with a random effect model and the I(2) statistic was used to estimate heterogeneity. RESULTS A total of five RCTs were included in the meta-analysis. For immunogenicity outcomes, QIV had similar efficacy for the three common strains; A/H1N1, A/H3N2 and the B lineage included in the TIV. QIV also showed superior efficacy for the B lineage not included in the TIV; pooled seroprotection RR of 1.14 (95%CI: 1.03-1.25, p=0.008) and seroconversion RR of 1.78 (95%CI: 1.24-2.55, p=0.002) for B/Victoria, and pooled seroprotection RR of 1.12 (95%CI: 1.02-1.22, p=0.01) and seroconversion RR of 2.11 (95%CI: 1.51-2.95, p<0.001) for B/Yamagata, respectively. No significant differences were found between QIV and TIV for aggregated local and systemic adverse events within 7days post-vaccination. There were no vaccine-related serious adverse events reported for either QIV or TIV. Compared to TIV, injection-site pain was more common for QIV, with a pooled RR of 1.18 (95%CI: 1.03-1.35, p=0.02). CONCLUSION In adults, inactivated QIV was as immunogenic as seasonal TIV, with equivalent efficacy against the shared three strains included in TIV, and a superior immunogenicity against the non-TIV B lineage.
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Affiliation(s)
- Aye M Moa
- School of Public Health and Community Medicine, University of New South Wales, NSW, Sydney, Australia.
| | - Abrar A Chughtai
- School of Public Health and Community Medicine, University of New South Wales, NSW, Sydney, Australia
| | - David J Muscatello
- School of Public Health and Community Medicine, University of New South Wales, NSW, Sydney, Australia
| | - Robin M Turner
- School of Public Health and Community Medicine, University of New South Wales, NSW, Sydney, Australia
| | - C Raina MacIntyre
- School of Public Health and Community Medicine, University of New South Wales, NSW, Sydney, Australia; College of Public Service & Community Solutions, Arizona State University, Phoenix, AZ, United States
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Wang L, Chandrasekaran V, Domachowske JB, Li P, Innis BL, Jain VK. Immunogenicity and Safety of an Inactivated Quadrivalent Influenza Vaccine in US Children 6-35 Months of Age During 2013-2014: Results From A Phase II Randomized Trial. J Pediatric Infect Dis Soc 2016; 5:170-9. [PMID: 26407273 PMCID: PMC5407130 DOI: 10.1093/jpids/piv041] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 06/09/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Viruses from 2 influenza B lineages co-circulate, leading to suboptimal protection with trivalent influenza vaccines (TIV). Quadrivalent influenza vaccines (QIV) containing both lineages offer broader protection. METHODS We compared inactivated seasonal QIV versus TIV (15 and 7.5 μg hemagglutinin [HA] for each influenza strain, respectively) in a phase II randomized (1 : 1), observer-blind trial in US children 6-35 months of age (identifier NCT01974895). The primary objective was to evaluate immune responses induced by QIV for the 4 vaccine strains 28 days after completion of vaccination. A secondary objective was to demonstrate superiority of QIV versus TIV for the B/Victoria strain contained in QIV but not TIV. Immunogenicity was evaluated in the per-protocol cohort (N = 280), and safety was evaluated in the intent-to-treat cohort (N = 314). RESULTS Seroconversion rates (SCRs) for QIV were 80.4% (95% confidence interval [CI], 73.0%-86.6%), 72.0% (95% CI, 63.9%-79.2%), 86.0% (95% CI, 79.2%-91.2%), and 66.4% (95% CI, 58.1%-74.1%) for A/H1N1, A/H3N2, B/Yamagata, and B/Victoria, respectively. Quadrivalent influenza vaccines demonstrated immunogenic superiority over TIV for B/Victoria with a geometric mean titer ratio of 4.73 (95% CI, 3.73%-5.99%) and SCR difference of 54.02% (95% CI, 43.88%-62.87%). Safety was similar between the vaccine groups despite the QIV's higher antigen content. No serious adverse events were reported related to vaccination. CONCLUSIONS Quadrivalent influenza vaccine (15 µg HA/strain) was immunogenic with an acceptable safety profile. The next phase of its development in children 6-35 months of age is a phase III trial in countries where it is not yet licensed. In countries where it is already licensed, a switch from TIV to QIV would provide broader protection in this vulnerable group.
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Affiliation(s)
- Long Wang
- GSK Vaccines, Vaccine Discovery and Development, King of Prussia, Pennsylvania
| | | | | | - Ping Li
- GSK Vaccines, Biostatistics, King of Prussia, Pennsylvania
| | - Bruce L. Innis
- GSK Vaccines, Vaccine Discovery and Development, King of Prussia, Pennsylvania
| | - Varsha K. Jain
- GSK Vaccines, Vaccine Discovery and Development, King of Prussia, Pennsylvania
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Crépey P, de Boer PT, Postma MJ, Pitman R. Retrospective public health impact of a quadrivalent influenza vaccine in the United States. Influenza Other Respir Viruses 2016; 9 Suppl 1:39-46. [PMID: 26256294 PMCID: PMC4549101 DOI: 10.1111/irv.12318] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2015] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Vaccination is an effective preventive strategy against influenza. However, current trivalent influenza vaccines (TIVs) contain only one of the two influenza B lineages that circulate each year. Vaccine mismatches are frequent because predicting which one will predominate is difficult. Recently licensed quadrivalent influenza vaccines (QIVs) containing the two B lineages should address this issue. Our study estimates their impact by assessing what would have been the US public health benefit of routinely vaccinating with QIV in 2000-2013. METHODS We developed a dynamic compartmental model that accounts for interactions between influenza B lineages (natural or vaccine-induced) and simulates the multiyear influenza dynamics for 2000-2013. Age-structured population dynamics, vaccine efficacy (VE) per strain, and weekly ramp-up of vaccination coverage are modeled. Sensitivity analyses were performed on VE, duration of immunity, and levels of vaccine-induced cross-protection between B lineages. RESULTS Assuming a cross-protection of 70% of the VE of the matched vaccine, the model predicts 16% more B lineage cases prevented by QIV. Elderly (≥65 years) and young seniors (50-64 years) benefit most from QIV, with 21% and 18% reductions in B lineage cases. Reducing cross-protection to 50%, 30%, and 0% of the VE of the matched vaccine improves the relative benefit of QIV to 25%, 30%, and 34% less B lineage cases. CONCLUSION Using a dynamic retrospective framework with real-life vaccine mismatch, our analysis shows that QIV routine vaccination in the United States has the potential to substantially reduce the number of influenza infections, even with relatively high estimates of TIV-induced cross-protection.
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Affiliation(s)
- Pascal Crépey
- EHESP Rennes, Sorbonne Paris-cité, Paris, France.,Aix-Marseille Univ, UMR EPV Emergence des Pathologies Virales-190, Marseille, France
| | - Pieter T de Boer
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Maarten J Postma
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.,Institute of Science in Healthy Aging & health caRE (SHARE), University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
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Tsurudome Y, Kimachi K, Okada Y, Matsuura K, Ooyama Y, Ibaragi K, Kino Y, Ueda K. Immunogenicity and safety of an inactivated quadrivalent influenza vaccine in healthy adults: a phase II, open-label, uncontrolled trial in Japan. Microbiol Immunol 2016; 59:597-604. [PMID: 26272602 DOI: 10.1111/1348-0421.12316] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/04/2015] [Accepted: 08/11/2015] [Indexed: 11/26/2022]
Abstract
Two antigenically distinct B strain lineages of influenza virus have co-circulated since the mid-1980s; however, inactivated trivalent influenza vaccines contain only one B lineage. The mismatch between the circulating and vaccine lineages has been a worldwide issue. In this study, an inactivated quadrivalent influenza vaccine (QIV) candidate containing two B lineages was manufactured and its immunogenicity and safety evaluated in an open-label, uncontrolled trial. In this phase II trial, 50 subjects aged 20-64 years received two doses of QIV s.c. 1 to 4 weeks apart. Sera were collected pre- and post-vaccination and safety assessed from the first vaccination to 21 ± 7 days after the second vaccination. After the first vaccination, hemagglutination inhibition titers against each strain increased markedly; the seroconversion rate, geometric mean titer ratio and seroprotection rate being 94.0%, 24.93, and 100.0%, respectively, for the A/H1N1pdm09 strain; 94.0%, 12.47, and 98.0%, respectively, for the A/H3N2 strain; 54.0%, 4.99, and 66.0%, respectively, for B/Yamagata strain, and 72.0%, 6.23 and 80.0%, respectively, for the B/Victoria strain, thus fulfilling the criteria of the European Medical Agency's Committee for Medicinal Products for Human Use. Also, the QIV induced sufficient single radial hemolysis and neutralizing antibodies against all four vaccine strains. No noteworthy adverse events were noted. The results of this trial demonstrate that QIV is well tolerated and immunogenic for each strain, suggesting that QIV potentially improves protection against influenza B by resolving the issue of B lineage mismatch.
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Affiliation(s)
- Yukari Tsurudome
- The Chemo-Sero-Therapeutic Research Institute (Kaketsuken), Kikuchi Research Center, 1314-1, Kyokushi-Kawabe, Kikuchi, 869-1298
| | - Kazuhiko Kimachi
- The Chemo-Sero-Therapeutic Research Institute (Kaketsuken), Kikuchi Research Center, 1314-1, Kyokushi-Kawabe, Kikuchi, 869-1298
| | - Yusuke Okada
- The Chemo-Sero-Therapeutic Research Institute (Kaketsuken), Kikuchi Research Center, 1314-1, Kyokushi-Kawabe, Kikuchi, 869-1298
| | - Kenta Matsuura
- The Chemo-Sero-Therapeutic Research Institute (KAKETSUKEN), Headquarters, 1-6-1, Okubo, Kumamoto, 860-8568
| | - Yusuke Ooyama
- The Chemo-Sero-Therapeutic Research Institute (KAKETSUKEN), Headquarters, 1-6-1, Okubo, Kumamoto, 860-8568
| | - Kayo Ibaragi
- The Chemo-Sero-Therapeutic Research Institute (Kaketsuken), Kikuchi Research Center, 1314-1, Kyokushi-Kawabe, Kikuchi, 869-1298
| | - Yoichiro Kino
- The Chemo-Sero-Therapeutic Research Institute (Kaketsuken), Kikuchi Research Center, 1314-1, Kyokushi-Kawabe, Kikuchi, 869-1298
| | - Kohji Ueda
- Seinan Jo Gakuin University, 1-3-5 Ibori, Kokura Kita-ku, Kitakyushu 803-0835, Japan
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Uhart M, Bricout H, Clay E, Largeron N. Public health and economic impact of seasonal influenza vaccination with quadrivalent influenza vaccines compared to trivalent influenza vaccines in Europe. Hum Vaccin Immunother 2016; 12:2259-68. [PMID: 27166916 PMCID: PMC5027718 DOI: 10.1080/21645515.2016.1180490] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Influenza B strains represent on average 23% of all circulating strains in Europe and when there is a vaccine mismatch on B strains, additional influenza-related hospitalizations and deaths as well as substantial additional costs are observed. The objective was to estimate the public health and economic impact of seasonal influenza vaccination with quadrivalent influenza vaccines (QIV) compared to trivalent influenza vaccines (TIV) in Europe (EU). Based on data from 5 EU countries (France, Germany, Italy, Spain and UK) during 10 influenza seasons from 2002 to 2013, epidemiological and associated economic outcomes were estimated for each season for the actual scenario where the TIV was used, and for a hypothetical scenario where QIV could have been used instead. By using QIV, this study estimated that for the 5 EU countries, an additional 1.03 million (327.9/100,000 inhabitants) influenza cases, 453,000 (143.9/100,000) general practitioners consultations, 672,000 (213.1/100,000) workdays lost, 24,000 (7.7/100,000) hospitalizations and 10,000 (3.1/100,000) deaths could have been avoided compared to the use of TIV over the 10-seasons-period. This study estimates that QIV can be of economic value since from a societal perspective 15 million Euros would have been saved on general practitioners consultations (14 million Euros from third-party payer perspective), 77 million on hospitalizations (74 million Euros from third-party payer perspective) and 150 million Euros on workdays lost, across the 5 EU countries. In conclusion, the present study estimates that, compared to TIV, QIV may result in a substantial decrease in epidemiological burden and in influenza-related costs.
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Affiliation(s)
- Mathieu Uhart
- a Sanofi Pasteur MSD, Market Access and Health Outcomes , Lyon , France
| | - Hélène Bricout
- b Sanofi Pasteur MSD , Epidemiology Department , Lyon , France
| | - Emilie Clay
- c Creativ-Ceutical, Health Economics and Outcomes Research , Paris , France
| | - Nathalie Largeron
- a Sanofi Pasteur MSD, Market Access and Health Outcomes , Lyon , France
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Kittikraisak W, Chittaganpitch M, Gregory CJ, Laosiritaworn Y, Thantithaveewat T, Dawood FS, Lindblade KA. Assessment of potential public health impact of a quadrivalent inactivated influenza vaccine in Thailand. Influenza Other Respir Viruses 2016; 10:211-9. [PMID: 26588892 PMCID: PMC4814859 DOI: 10.1111/irv.12361] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Each year, an influenza B strain representing only one influenza B lineage is included in the trivalent inactivated influenza vaccine (IIV3); a mismatch between the selected lineage and circulating viruses can result in suboptimal vaccine effectiveness. We modeled the added potential public health impact of a quadrivalent inactivated influenza vaccine (IIV4) that includes strains from both influenza B lineages compared to IIV3 on influenza-associated morbidity and mortality in Thailand. METHODS Using data on the incidence of influenza-associated hospitalizations and deaths, vaccine effectiveness, and vaccine coverage from the 2007-2012 influenza seasons in Thailand, we estimated rates of influenza-associated outcomes that might be averted using IIV4 instead of IIV3. We then applied these rates to national population estimates to calculate averted illnesses, hospitalizations, and deaths for each season. We assumed that the influenza B lineage included in IIV3 would provide a relative vaccine effectiveness of 75% against the other B lineage. RESULTS Compared to use of IIV3, use of IIV4 might have led to an additional reduction ranging from 0·4 to 14·3 influenza-associated illnesses per 100 000 population/year, <0·1 to 0·5 hospitalizations per 100 000/year, and <0·1 to 0·4 deaths per 1000/year. Based on extrapolation to national population estimates, replacement of IIV3 with IIV4 might have averted an additional 267-9784 influenza-associated illnesses, 9-320 hospitalizations, and 0-3 deaths. CONCLUSION Compared to use of IIV3, IIV4 has the potential to further reduce the burden of influenza-associated morbidity and mortality in Thailand.
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Affiliation(s)
- Wanitchaya Kittikraisak
- Influenza ProgramThailand Ministry of Public Health – U.S. Centers for Disease Control and Prevention CollaborationNonthaburiThailand
| | | | - Christopher J. Gregory
- International Emerging Infections ProgramThailand Ministry of Public Health – U.S. Centers for Disease Control and Prevention CollaborationNonthaburiThailand
- Division of Global Health ProtectionU.S. Centers for Disease Control and PreventionAtlantaGAUSA
| | | | | | - Fatimah S. Dawood
- Influenza DivisionU.S. Centers for Disease Control and PreventionAtlantaGAUSA
| | - Kim A. Lindblade
- Influenza ProgramThailand Ministry of Public Health – U.S. Centers for Disease Control and Prevention CollaborationNonthaburiThailand
- Influenza DivisionU.S. Centers for Disease Control and PreventionAtlantaGAUSA
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Mosterín Höpping A, Fonville JM, Russell CA, James S, Smith DJ. Influenza B vaccine lineage selection--an optimized trivalent vaccine. Vaccine 2016; 34:1617-1622. [PMID: 26896685 PMCID: PMC4793086 DOI: 10.1016/j.vaccine.2016.01.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 01/20/2016] [Indexed: 11/27/2022]
Abstract
Epidemics of seasonal influenza viruses cause considerable morbidity and mortality each year. Various types and subtypes of influenza circulate in humans and evolve continuously such that individuals at risk of serious complications need to be vaccinated annually to keep protection up to date with circulating viruses. The influenza vaccine in most parts of the world is a trivalent vaccine, including an antigenically representative virus of recently circulating influenza A/H3N2, A/H1N1, and influenza B viruses. However, since the 1970s influenza B has split into two antigenically distinct lineages, only one of which is represented in the annual trivalent vaccine at any time. We describe a lineage selection strategy that optimizes protection against influenza B using the standard trivalent vaccine as a potentially cost effective alternative to quadrivalent vaccines.
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Affiliation(s)
| | - Judith M Fonville
- Department of Zoology, University of Cambridge, Cambridge, United Kingdom; Department of Virology, Erasmus MC, Rotterdam, The Netherlands
| | - Colin A Russell
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Sarah James
- Department of Zoology, University of Cambridge, Cambridge, United Kingdom
| | - Derek J Smith
- Department of Zoology, University of Cambridge, Cambridge, United Kingdom; Department of Virology, Erasmus MC, Rotterdam, The Netherlands.
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Barberis I, Martini M, Iavarone F, Orsi A. Available influenza vaccines: immunization strategies, history and new tools for fighting the disease. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2016; 57:E41-6. [PMID: 27346939 PMCID: PMC4910442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 02/25/2016] [Indexed: 11/28/2022]
Abstract
The main public health strategy for containing influenza-related disease is annual vaccination, which is recommended for the elderly and others belonging to risk-factor categories, who present the highest morbidity and mortality, as reported by the World Health Organization (WHO) Recommendations. The availability of different influenza vaccine formulations makes the choice of the best immunization strategy a challenge for stakeholders and public health experts. Heterogeneity in at-risk categories included in national influenza vaccine recommendations still exists, in particular among European countries. Broader consensus is expected, which should positively impact on influenza vaccination coverage. The availability of quadrivalent vaccines, containing both influenza B lineages, offers the potential to improve protection by overcoming the drawbacks of wrongly predicting which B lineage will predominate in a given year.
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Affiliation(s)
- I. Barberis
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - M. Martini
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - F. Iavarone
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - A. Orsi
- Department of Health Sciences, University of Genoa, Genoa, Italy
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48
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Thommes EW, Ismaila A, Chit A, Meier G, Bauch CT. Cost-effectiveness evaluation of quadrivalent influenza vaccines for seasonal influenza prevention: a dynamic modeling study of Canada and the United Kingdom. BMC Infect Dis 2015; 15:465. [PMID: 26503131 PMCID: PMC4623926 DOI: 10.1186/s12879-015-1193-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 10/07/2015] [Indexed: 02/08/2023] Open
Abstract
Background The adoption of quadrivalent influenza vaccine (QIV) to replace trivalent influenza vaccine (TIV) in immunization programs is growing worldwide, thus helping to address the problem of influenza B lineage mismatch. However, the price per dose of QIV is higher than that of TIV. In such circumstances, cost-effectiveness analyses provide important and relevant information to inform national health recommendations and implementation decisions. This analysis assessed potential vaccine impacts and cost-effectiveness of a country-wide switch from TIV to QIV, in Canada and the UK, from a third-party payer perspective. Methods An age-stratified, dynamic four-strain transmission model which incorporates strain interaction, transmission-rate seasonality and age-specific mixing in the population was used. Model input data were obtained from published literature and online databases. In Canada, we evaluated a switch from TIV to QIV in the entire population. For the UK, we considered two strategies: Children aged 2–17 years who receive the live-attenuated influenza vaccine (LAIV) switch to the quadrivalent formulation (QLAIV), while individuals aged > 18 years switch from TIV to QIV. Two different vaccination uptake scenarios in children (UK1 and UK2, which differ in the vaccine uptake level) were considered. Health and cost outcomes for both vaccination strategies, and the cost-effectiveness of switching from TIV/LAIV to QIV/QLAIV, were estimated from the payer perspective. For Canada and the UK, cost and outcomes were discounted using 5 % and 3.5 % per year, respectively. Results Overall, in an average influenza season, our model predicts that a nationwide switch from TIV to QIV would prevent 4.6 % influenza cases, 4.9 % general practitioner (GP) visits, 5.7 % each of emergency room (ER) visits and hospitalizations, and 6.8 % deaths in Canada. In the UK (UK1/UK2), implementing QIV would prevent 1.4 %/1.8 % of influenza cases, 1.6 %/2.0 % each of GP and ER visits, 1.5 %/1.9 % of hospitalizations and 4.3 %/4.9 % of deaths. Discounted incremental cost-utility ratios of $7,961 and £7,989/£7,234 per quality-adjusted life-year (QALY) gained are estimated for Canada and the UK (UK1/UK2), both of which are well within their respective cost-effectiveness threshold values. Conclusions Switching from TIV to QIV is expected to be a cost-effective strategy to further reduce the burden of influenza in both countries. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1193-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Edward W Thommes
- GSK, 7333 Mississauga Road, Mississauga, ON, L5N 6L4, Canada. .,Department of Mathematics & Statistics, University of Guelph, Guelph, Ontario, Canada.
| | - Afisi Ismaila
- GSK, 7333 Mississauga Road, Mississauga, ON, L5N 6L4, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
| | - Ayman Chit
- Sanofi Pasteur, Toronto, Ontario, Canada. .,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
| | | | - Christopher T Bauch
- Department of Applied Mathematics, University of Waterloo, Waterloo, Ontario, Canada.
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Mosnier A, Caini S, Daviaud I, Bensoussan JL, Stoll-Keller F, Bui TT, Lina B, Van der Werf S, Cohen JM. Ten influenza seasons in France: distribution and timing of influenza A and B circulation, 2003-2013. BMC Infect Dis 2015; 15:357. [PMID: 26289794 PMCID: PMC4545988 DOI: 10.1186/s12879-015-1056-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 07/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Describing the circulation of influenza viruses and the characteristics of seasonal epidemics remains an essential tool to optimize the strategies of influenza prevention and control. Special attention has been recently paid to influenza B in the context of the availability of a quadrivalent vaccine, containing two influenza B strains. METHODS We used data from a practitioners-based influenza surveillance network to describe the circulation of influenza viruses in France from 2003-2004 to 2012-2013. Nasopharyngeal swabs taken from acute respiratory infection (ARI) patients between October and April were tested for influenza. We reported the number of influenza cases by virus type (A, B), subtype (A(H1), A(H3)) and B lineage (Yamagata, Victoria) in each season and determined the frequency of influenza B vaccine mismatch. We estimated weekly incidence of influenza by extrapolating reported influenza cases to the French population. We compared the temporal characteristics of the epidemics caused by influenza A(H1), A(H3) and B. RESULTS Overall, 49,919 ARI patients were tested, of which 16,287 (32.6 %) were positive for influenza. Type B virus caused 23.7 % of all influenza cases. Virus subtypes A(H1) and A(H3) caused 51.6 % and 48.4 % of influenza A cases, respectively. Viruses of the B-Yamagata and B-Victoria lineage caused 62.8 % and 37.2 % of influenza B cases, respectively. There was an influenza B vaccine mismatch in three of the five seasons where influenza B caused 10 % or more of all influenza cases. Influenza A(H3) had the highest average value of estimated weekly incidence during the study period. Influenza B peaked an average 3.8 weeks later than influenza A when both virus types were circulating. No differences in the duration of influenza A and B epidemics were observed. CONCLUSIONS Influenza A(H3) was the most prevalent influenza type during the study period. Influenza B caused around one fourth of all influenza cases and tended to circulate later than influenza A. The frequency of influenza B vaccine mismatches was substantial. Timely data on the circulation of influenza viruses collected within influenza surveillance systems are essential to optimize influenza prevention and control strategies.
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Affiliation(s)
- Anne Mosnier
- Open Rome (Organize and Promote Epidemiological Network), 67 rue du Poteau, 75018, Paris, France.
- Réseau des GROG, 67 rue du Poteau, 75018, Paris, France.
| | - Saverio Caini
- Open Rome (Organize and Promote Epidemiological Network), 67 rue du Poteau, 75018, Paris, France.
| | - Isabelle Daviaud
- Open Rome (Organize and Promote Epidemiological Network), 67 rue du Poteau, 75018, Paris, France.
- Réseau des GROG, 67 rue du Poteau, 75018, Paris, France.
| | | | | | - Tan Tai Bui
- Open Rome (Organize and Promote Epidemiological Network), 67 rue du Poteau, 75018, Paris, France.
| | - Bruno Lina
- CNR des virus influenzae, CBPE, HCL & Virpath, UCBL, Université de Lyon, Lyon, France.
| | - Sylvie Van der Werf
- CNR des virus influenzae, GMVR Institut Pasteur, CNRS UMR3569, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
| | - Jean Marie Cohen
- Open Rome (Organize and Promote Epidemiological Network), 67 rue du Poteau, 75018, Paris, France.
- Réseau des GROG, 67 rue du Poteau, 75018, Paris, France.
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Chit A, Roiz J, Aballea S. An Assessment of the Expected Cost-Effectiveness of Quadrivalent Influenza Vaccines in Ontario, Canada Using a Static Model. PLoS One 2015. [PMID: 26222538 PMCID: PMC4519190 DOI: 10.1371/journal.pone.0133606] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Ontario, Canada, immunizes against influenza using a trivalent inactivated influenza vaccine (IIV3) under a Universal Influenza Immunization Program (UIIP). The UIIP offers IIV3 free-of-charge to all Ontarians over 6 months of age. A newly approved quadrivalent inactivated influenza vaccine (IIV4) offers wider protection against influenza B disease. We explored the expected cost-utility and budget impact of replacing IIV3 with IIV4, within the context of Ontario’s UIIP, using a probabilistic and static cost-utility model. Wherever possible, epidemiological and cost data were obtained from Ontario sources. Canadian or U.S. sources were used when Ontario data were not available. Vaccine efficacy for IIV3 was obtained from the literature. IIV4 efficacy was derived from meta-analysis of strain-specific vaccine efficacy. Conservatively, herd protection was not considered. In the base case, we used IIV3 and IIV4 prices of $5.5/dose and $7/dose, respectively. We conducted a sensitivity analysis on the price of IIV4, as well as standard univariate and multivariate statistical uncertainty analyses. Over a typical influenza season, relative to IIV3, IIV4 is expected to avert an additional 2,516 influenza cases, 1,683 influenza-associated medical visits, 27 influenza-associated hospitalizations, and 5 influenza-associated deaths. From a societal perspective, IIV4 would generate 76 more Quality Adjusted Life Years (QALYs) and a net societal budget impact of $4,784,112. The incremental cost effectiveness ratio for this comparison was $63,773/QALY. IIV4 remains cost-effective up to a 53% price premium over IIV3. A probabilistic sensitivity analysis showed that IIV4 was cost-effective with a probability of 65% for a threshold of $100,000/QALY gained. IIV4 is expected to achieve reductions in influenza-related morbidity and mortality compared to IIV3. Despite not accounting for herd protection, IIV4 is still expected to be a cost-effective alternative to IIV3 up to a price premium of 53%. Our conclusions were robust in the face of sensitivity analyses.
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Affiliation(s)
- Ayman Chit
- Health Outcomes and Economics—North America, Sanofi Pasteur, Toronto, Ontario, Canada
- Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Julie Roiz
- Creativ-Ceutical Ltd, London, United Kingdom
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