An Economic Evaluation of the Adjuvanted Quadrivalent Influenza Vaccine Compared with Standard-Dose Quadrivalent Influenza Vaccine in the Spanish Older Adult Population
Standard-dose quadrivalent influenza vaccines (QIV) are designed to provide protection against all four influenza strains. Adjuvanted QIV (aQIV), indicated for individuals aged 65+ years, combines MF59<sup>®</sup> adjuvant (an oil-in-water emulsion of squalene oil) with a standard dose o...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-08-01
|
| Series: | Vaccines |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2076-393X/10/8/1360 |
| _version_ | 1827598009843580928 |
|---|---|
| author | Anna Fochesato Sara Sottile Andrea Pugliese Sergio Márquez-Peláez Hector Toro-Diaz Ray Gani Piedad Alvarez Jesús Ruiz-Aragón |
| author_facet | Anna Fochesato Sara Sottile Andrea Pugliese Sergio Márquez-Peláez Hector Toro-Diaz Ray Gani Piedad Alvarez Jesús Ruiz-Aragón |
| author_sort | Anna Fochesato |
| collection | DOAJ |
| description | Standard-dose quadrivalent influenza vaccines (QIV) are designed to provide protection against all four influenza strains. Adjuvanted QIV (aQIV), indicated for individuals aged 65+ years, combines MF59<sup>®</sup> adjuvant (an oil-in-water emulsion of squalene oil) with a standard dose of antigen, and is designed to produce stronger and longer immune response, especially in the elderly where immunosenescence reduces vaccine effectiveness. This study evaluated the cost-effectiveness of aQIV vs. egg-based standard-dose QIV (QIVe) in the elderly population, from the payer and societal perspective in Spain. A dynamic transmission model, which accounts for herd protection, was used to predict the number of medically attended infections in Spain. A decision tree structure was used to forecast influenza-related costs and benefits. Influenza-related probabilities of outpatient visit, hospitalization, work absenteeism, mortality, and associated utilities and costs were extracted from Spanish and European published literature. Relative vaccine effectiveness (rVE) was sourced from two different meta-analyses: the first meta-analysis was informed by laboratory-confirmed influenza studies only, resulting in a rVE = 34.6% (CI95% 2–66%) in favor of aQIV; the second meta-analysis included real world evidence influenza-related medical encounters outcomes, resulting in a rVE = 13.9% (CI95% 4.2–23.5%) in benefit of aQIV. All costs were expressed in 2021 euros. Results indicate that replacing QIVe with aQIV in the Spanish elderly population would prevent on average 43,664 influenza complicated cases, 1111 hospitalizations, and 569 deaths (with a rVE = 34.6%) or 19,104 influenza complicated cases, 486 hospitalizations, and 252 deaths (with a rVE = 13.9%). When the rVE of aQIV vs. QIVe is 34.6%, the incremental cost per quality adjusted life years (QALY) gained was €2240 from the payer; from the societal perspective, aQIV was cost saving compared with QIVe. If the rVE was 13.9%, the incremental cost per QALY was €6694 and €3936 from the payer and societal perspective, respectively. Sensitivity analyses validated the robustness of these findings. Results indicate that replacing QIVe with aQIV in the Spanish elderly population is a cost-effective strategy for the Spanish healthcare system. |
| first_indexed | 2024-03-09T03:42:30Z |
| format | Article |
| id | doaj.art-6d83a14be09648cba151b66c9c9f0861 |
| institution | Directory Open Access Journal |
| issn | 2076-393X |
| language | English |
| last_indexed | 2024-03-09T03:42:30Z |
| publishDate | 2022-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Vaccines |
| spelling | doaj.art-6d83a14be09648cba151b66c9c9f08612023-12-03T14:37:57ZengMDPI AGVaccines2076-393X2022-08-01108136010.3390/vaccines10081360An Economic Evaluation of the Adjuvanted Quadrivalent Influenza Vaccine Compared with Standard-Dose Quadrivalent Influenza Vaccine in the Spanish Older Adult PopulationAnna Fochesato0Sara Sottile1Andrea Pugliese2Sergio Márquez-Peláez3Hector Toro-Diaz4Ray Gani5Piedad Alvarez6Jesús Ruiz-Aragón7Department of Mathematics, University of Trento, Via Sommarive 14, 38123 Trento, ItalyDepartment of Mathematics, University of Trento, Via Sommarive 14, 38123 Trento, ItalyDepartment of Mathematics, University of Trento, Via Sommarive 14, 38123 Trento, ItalyDepartment of Economics, Faculty of Business, Universidad Pablo de Olavide, 41013 Sevilla, SpainEvidence, Modeling and Synthesis, Evidera, Waltham, MA 02451, USAEvidence, Modeling, and Synthesis, Evidera, London W6 8BJ, UKEvidence, Modeling, and Synthesis, Evidera, London W6 8BJ, UKHospital de La Línea, 11300 La Línea de la Concepción, SpainStandard-dose quadrivalent influenza vaccines (QIV) are designed to provide protection against all four influenza strains. Adjuvanted QIV (aQIV), indicated for individuals aged 65+ years, combines MF59<sup>®</sup> adjuvant (an oil-in-water emulsion of squalene oil) with a standard dose of antigen, and is designed to produce stronger and longer immune response, especially in the elderly where immunosenescence reduces vaccine effectiveness. This study evaluated the cost-effectiveness of aQIV vs. egg-based standard-dose QIV (QIVe) in the elderly population, from the payer and societal perspective in Spain. A dynamic transmission model, which accounts for herd protection, was used to predict the number of medically attended infections in Spain. A decision tree structure was used to forecast influenza-related costs and benefits. Influenza-related probabilities of outpatient visit, hospitalization, work absenteeism, mortality, and associated utilities and costs were extracted from Spanish and European published literature. Relative vaccine effectiveness (rVE) was sourced from two different meta-analyses: the first meta-analysis was informed by laboratory-confirmed influenza studies only, resulting in a rVE = 34.6% (CI95% 2–66%) in favor of aQIV; the second meta-analysis included real world evidence influenza-related medical encounters outcomes, resulting in a rVE = 13.9% (CI95% 4.2–23.5%) in benefit of aQIV. All costs were expressed in 2021 euros. Results indicate that replacing QIVe with aQIV in the Spanish elderly population would prevent on average 43,664 influenza complicated cases, 1111 hospitalizations, and 569 deaths (with a rVE = 34.6%) or 19,104 influenza complicated cases, 486 hospitalizations, and 252 deaths (with a rVE = 13.9%). When the rVE of aQIV vs. QIVe is 34.6%, the incremental cost per quality adjusted life years (QALY) gained was €2240 from the payer; from the societal perspective, aQIV was cost saving compared with QIVe. If the rVE was 13.9%, the incremental cost per QALY was €6694 and €3936 from the payer and societal perspective, respectively. Sensitivity analyses validated the robustness of these findings. Results indicate that replacing QIVe with aQIV in the Spanish elderly population is a cost-effective strategy for the Spanish healthcare system.https://www.mdpi.com/2076-393X/10/8/1360influenzavaccinationSpaincost-effectivenessadjuvantedquadrivalent vaccine |
| spellingShingle | Anna Fochesato Sara Sottile Andrea Pugliese Sergio Márquez-Peláez Hector Toro-Diaz Ray Gani Piedad Alvarez Jesús Ruiz-Aragón An Economic Evaluation of the Adjuvanted Quadrivalent Influenza Vaccine Compared with Standard-Dose Quadrivalent Influenza Vaccine in the Spanish Older Adult Population Vaccines influenza vaccination Spain cost-effectiveness adjuvanted quadrivalent vaccine |
| title | An Economic Evaluation of the Adjuvanted Quadrivalent Influenza Vaccine Compared with Standard-Dose Quadrivalent Influenza Vaccine in the Spanish Older Adult Population |
| title_full | An Economic Evaluation of the Adjuvanted Quadrivalent Influenza Vaccine Compared with Standard-Dose Quadrivalent Influenza Vaccine in the Spanish Older Adult Population |
| title_fullStr | An Economic Evaluation of the Adjuvanted Quadrivalent Influenza Vaccine Compared with Standard-Dose Quadrivalent Influenza Vaccine in the Spanish Older Adult Population |
| title_full_unstemmed | An Economic Evaluation of the Adjuvanted Quadrivalent Influenza Vaccine Compared with Standard-Dose Quadrivalent Influenza Vaccine in the Spanish Older Adult Population |
| title_short | An Economic Evaluation of the Adjuvanted Quadrivalent Influenza Vaccine Compared with Standard-Dose Quadrivalent Influenza Vaccine in the Spanish Older Adult Population |
| title_sort | economic evaluation of the adjuvanted quadrivalent influenza vaccine compared with standard dose quadrivalent influenza vaccine in the spanish older adult population |
| topic | influenza vaccination Spain cost-effectiveness adjuvanted quadrivalent vaccine |
| url | https://www.mdpi.com/2076-393X/10/8/1360 |
| work_keys_str_mv | AT annafochesato aneconomicevaluationoftheadjuvantedquadrivalentinfluenzavaccinecomparedwithstandarddosequadrivalentinfluenzavaccineinthespanisholderadultpopulation AT sarasottile aneconomicevaluationoftheadjuvantedquadrivalentinfluenzavaccinecomparedwithstandarddosequadrivalentinfluenzavaccineinthespanisholderadultpopulation AT andreapugliese aneconomicevaluationoftheadjuvantedquadrivalentinfluenzavaccinecomparedwithstandarddosequadrivalentinfluenzavaccineinthespanisholderadultpopulation AT sergiomarquezpelaez aneconomicevaluationoftheadjuvantedquadrivalentinfluenzavaccinecomparedwithstandarddosequadrivalentinfluenzavaccineinthespanisholderadultpopulation AT hectortorodiaz aneconomicevaluationoftheadjuvantedquadrivalentinfluenzavaccinecomparedwithstandarddosequadrivalentinfluenzavaccineinthespanisholderadultpopulation AT raygani aneconomicevaluationoftheadjuvantedquadrivalentinfluenzavaccinecomparedwithstandarddosequadrivalentinfluenzavaccineinthespanisholderadultpopulation AT piedadalvarez aneconomicevaluationoftheadjuvantedquadrivalentinfluenzavaccinecomparedwithstandarddosequadrivalentinfluenzavaccineinthespanisholderadultpopulation AT jesusruizaragon aneconomicevaluationoftheadjuvantedquadrivalentinfluenzavaccinecomparedwithstandarddosequadrivalentinfluenzavaccineinthespanisholderadultpopulation AT annafochesato economicevaluationoftheadjuvantedquadrivalentinfluenzavaccinecomparedwithstandarddosequadrivalentinfluenzavaccineinthespanisholderadultpopulation AT sarasottile economicevaluationoftheadjuvantedquadrivalentinfluenzavaccinecomparedwithstandarddosequadrivalentinfluenzavaccineinthespanisholderadultpopulation AT andreapugliese economicevaluationoftheadjuvantedquadrivalentinfluenzavaccinecomparedwithstandarddosequadrivalentinfluenzavaccineinthespanisholderadultpopulation AT sergiomarquezpelaez economicevaluationoftheadjuvantedquadrivalentinfluenzavaccinecomparedwithstandarddosequadrivalentinfluenzavaccineinthespanisholderadultpopulation AT hectortorodiaz economicevaluationoftheadjuvantedquadrivalentinfluenzavaccinecomparedwithstandarddosequadrivalentinfluenzavaccineinthespanisholderadultpopulation AT raygani economicevaluationoftheadjuvantedquadrivalentinfluenzavaccinecomparedwithstandarddosequadrivalentinfluenzavaccineinthespanisholderadultpopulation AT piedadalvarez economicevaluationoftheadjuvantedquadrivalentinfluenzavaccinecomparedwithstandarddosequadrivalentinfluenzavaccineinthespanisholderadultpopulation AT jesusruizaragon economicevaluationoftheadjuvantedquadrivalentinfluenzavaccinecomparedwithstandarddosequadrivalentinfluenzavaccineinthespanisholderadultpopulation |