Abstract
ObjectivesDespite a high vaccine uptake rate of over 80% in South Korea, the disease burden of influenza is still high among the elderly, which may be due to low effectiveness of vaccines. Therefore, the cost-effectiveness of use among the elderly was analyzed in order to compare the current trivalent influenza vaccine (TIV) with a quadrivalent influenza vaccine (QIV) or MF59-adjuvanted trivalent influenza vaccine (ATIV).MethodsA static lifetime Markov model was used. It was assumed that the model would be repeated until individuals reached the age of 100. Cost-effectiveness was analyzed across three age groups (65–74 years, 75–84 years, and ≥85 years), and the at-risk group was studied.ResultsCompared to the TIV, the QIV was expected to reduce the number of influenza infections by 342,873, complications by 17,011, hospitalizations by 8,568, and deaths by 2,031. The QIV was highly cost-effective when compared to the TIV, with a base case incremental cost-effectiveness ratio (ICER) estimated at USD 17,699/QALY (1USD = 1,151KRW), and the ICER decreased with age and was USD 3,431/QALY in the group aged 85 and above. Sensitivity analysis revealed that the ICER was sensitive to the QIV price, the proportion of influenza B, and vaccine mismatching. On the other hand, the ATIV was expected to reduce the number of influenza cases and complications by 1,812,395 and 89,747, respectively, annually, yielding cost-saving among all ages. ATIV price and vaccine efficacy were the most influential parameters for the ICER of ATIV.ConclusionsThe QIV and ATIV strategies were considered more cost-effective in comparison to the TIV for vaccination strategies implemented for the elderly. However, owing to a lack of data on the effectiveness of ATIV among the elderly, a large-scale effectiveness study is required.
Highlights
Influenza is a viral respiratory disease occurring globally, causing socioeconomic losses by hindering healthy adults from working, and raising mortality and morbidity rates in high-risk groups
Compared to the trivalent influenza vaccine (TIV), the quadrivalent influenza vaccine (QIV) was expected to reduce the number of influenza infections by 342,873, complications by 17,011, hospitalizations by 8,568, and deaths by 2,031
The QIV was highly cost-effective when compared to the TIV, with a base case incremental costeffectiveness ratio (ICER) estimated at USD 17,699/QALY (1USD = 1,151KRW), and the ICER decreased with age and was USD 3,431/QALY in the group aged 85 and above
Summary
Influenza is a viral respiratory disease occurring globally, causing socioeconomic losses by hindering healthy adults from working, and raising mortality and morbidity rates in high-risk groups. In South Korea, approximately 7,000 patients are hospitalized and 400,000 are treated as outpatients annually during winters, for seasonal influenza. During a pandemic, such as the H1N1 that occurred in 2009, more than 10 times the normal number of patients was reported [1]. To reduce the disease burden of influenza, the government has recommended vaccination for the target groups, including children under 18, elderly people aged 50 and above, pregnant women, and those with chronic diseases. After the NIP was extended to private medical institutions in the 2015–16 influenza season the vaccination rate among elderly people aged 65 and above exceeded 80% [2, 3]
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