Abstract
Two influenza vaccines are licensed in the U.S. exclusively for the 65 years and older population: a trivalent inactivated high-dose influenza vaccine (HD-IIV3) and a trivalent inactivated adjuvanted influenza vaccine (aIIV3). In a recent publication, we estimated a relative vaccine effectiveness (rVE) of HD-IIV3 vs. aIIV3 of 12% (95% CI: 3.3–20%) for influenza-related hospitalizations using a retrospective study design, but did not report the number of prevented hospitalizations nor the associated avoided cost. In this paper we report estimations for both. Methods: Leveraging the rVE of a cohort study over two influenza seasons (2016/17 and 2017/18), we collected cost data for healthcare provided to the same study population. Vaccine costs were obtained from the Medicare pricing schedule. Our economic assessment compared cost of vaccination and hospital care for patients experiencing acute respiratory or cardiovascular illness. Results: We analyzed 1.9 million HD-IIV3 and 223,793 aIIV3 recipients. Average vaccine list prices were $46.23 for HD-IIV3 and $48.26 for aIIV3. The hospitalization rates for respiratory disease in HD-IIV3 and aIIV3 recipients were 187 (95% CI: 185–189) and 212 (195–231) per 10,000 persons-years, respectively. Attributing the average cost per hospitalization of $12,652 ($12,214–$13,090) to the difference in hospitalization rates, we estimate net savings of HD-IIV3 to be $34 ($10–$62) per recipient. Conclusion: Pooled over two predominantly A/H3N2 respiratory seasons, vaccination with HD-IIV3 was associated with lower hospitalization rates and associated costs compared to aIIV3 in senior members of a large national managed health care company in the U.S. Reduced hospitalizations affect healthcare utilization overall, and therefore other costly health outcomes.
Highlights
Adults 65 years and older are at greater risk for complications following influenza infection compared with younger adults, due in part to immunosenescence and increased comorbid conditions, leading to decreased vaccine efficacy and increased severity of influenza related complications [1,2,3]
Influenza vaccines licensed to age groups including but not limited to seniors are beyond the scope of this study and at the time of writing, a quadrivalent inactivated high-dose influenza vaccine (HD-IIV4) and a quadrivalent inactivated adjuvanted influenza vaccine have become available to
Vaccine exposure was ascertained by Current Procedural Terminology (CPT) codes, National Drug Codes (NDC) or brand names (Supplemental Table S1), The primary outcome was an acute hospitalization for respiratory disease, defined by its principal discharge diagnosis (International Classification of Diseases, Tenth Revision, [ICD-10]: Jxx)
Summary
Adults 65 years and older (hereinafter referred to as seniors) are at greater risk for complications following influenza infection compared with younger adults, due in part to immunosenescence and increased comorbid conditions, leading to decreased vaccine efficacy and increased severity of influenza related complications [1,2,3]. In the U.S, the annual cost of hospitalizations associated with influenza are estimated to be $1.3 billion for this age group [4]. Given this substantial cost, a health economic analysis of the various influenza vaccination strategies aiming to increase protection for this age group is pertinent. Influenza vaccines licensed to age groups including but not limited to seniors are beyond the scope of this study and at the time of writing, a quadrivalent inactivated high-dose influenza vaccine (HD-IIV4) and a quadrivalent inactivated adjuvanted influenza vaccine (aIIV4) have become available to
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