Cost-effectiveness of influenza vaccination with a high dose quadrivalent vaccine of the elderly population in Belgium, Finland, and Portugal
Fabián P. Alvarez, Pierre Chevalier, Matthias Borms, Hélène Bricout, Cátia Marques, Anu Soininen, T. Sainio, Christine Petit, Caroline de Courville
Abstract
Background Seasonal influenza may result in severe outcomes, resulting in a significant increase of hospitalizations during the winter. To improve the protection provided by the standard dose influenza quadrivalent vaccine (SDQIV), a high-dose vaccine (HDQIV) has been developed specifically for adults aged 60 and older who are at higher risk of life-threatening complications,Objectives The aim of this study was to determine the cost-effectiveness of HD QIV vs SD-QIV in the recommended population of three European countries: Belgium, Finland and Portugal.Methods A cost-utility analysis comparing HDQIV versus SDQIV was conducted using a decision tree estimating health outcomes conditional on influenza: cases, general practitioner and emergency department visits, hospitalizations and deaths. To account for the full benefit of the vaccine, an additional outcome – hospitalizations attributable to influenza – was also evaluated. Demographic, epidemiological and economic inputs were based on the respective local data. HDQIV relative vaccine efficacy versus SDQIV was obtained from a phase IV efficacy randomized clinical trial. The incremental cost-effectiveness ratios (ICER) were computed for each country, and a probabilistic sensitivity analysis (1,000 simulations per country) was performed to assess the robustness of the results.Results In the base case analysis, HDQIV resulted in improved health outcomes (visits, hospitalisations and deaths) compared to SDQIV. The ICERs computed were 1,397 €/QALY, 9,581 €/QALY and 15,267 €/QALY, whereas the PSA yielded 100%, 100% and 84% of simulations being cost-effective at their respective willingness-to-pay thresholds, for Belgium, Finland, and Portugal respectively.Conclusion In three European countries with different healthcare systems, HD-QIV would contribute to a significant improvement in the prevention of influenza health outcomes while being cost-effective.