Abstract
IntroductionThe propensity for influenza viruses to mutate and recombine makes them both a familiar threat and a prototype emerging infectious disease. Emerging evidence suggests that the use of MF59-adjuvanted vaccines in older adults and young children enhances protection against influenza infection and reduces adverse influenza-attributable outcomes compared to unadjuvanted vaccines. The health and economic impact of such vaccines in the Canadian population are uncertain.MethodsWe constructed an age-structured compartmental model simulating the transmission of influenza in the Canadian population over a ten-year period. We compared projected health outcomes (quality-adjusted life years (QALY) lost), costs, and incremental cost-effectiveness ratios (ICERs) for three strategies: (i) current use of unadjuvanted trivalent influenza vaccine; (ii) use of MF59-adjuvanted influenza vaccine adults ≥65 in the Canadian population, and (iii) adjuvanted vaccine used in both older adults and children aged < 6.ResultsIn the base case analysis, use of adjuvanted vaccine in older adults was highly cost-effective (ICER = $2111/QALY gained), but such a program was “dominated” by a program that extended the use of adjuvanted vaccine to include young children (ICER = $1612/QALY). Results were similar whether or not a universal influenza immunization program was used in other age groups; projections were robust in the face of wide-ranging sensitivity analyses.InterpretationBased on the best available data, it is projected that replacement of traditional trivalent influenza vaccines with MF59-adjuvanted vaccines would confer substantial benefits to vaccinated and unvaccinated individuals, and would be economically attractive relative to other widely-used preventive interventions.
Highlights
The propensity for influenza viruses to mutate and recombine makes them both a familiar threat and a prototype emerging infectious disease
Most influenza infections are self-limiting, they result in increased demands on health care services and are costly in terms of morbidity and lost productivity [2,3,4,5]
Unadjuvanted trivalent influenza vaccine (TIV), containing three specific subtypes of influenza expected to dominate during the upcoming influenza season, is currently used in Canada
Summary
The propensity for influenza viruses to mutate and recombine makes them both a familiar threat and a prototype emerging infectious disease. Emerging evidence suggests that the use of MF59-adjuvanted vaccines in older adults and young children enhances protection against influenza infection and reduces adverse influenza-attributable outcomes compared to unadjuvanted vaccines. Efficacy of unadjuvanted vaccine in older adults ($65) is typically lower than that observed in healthy adults [6]; this reduced efficacy may be due to a lowered antibody response to the vaccine in the elderly [7] To overcome this reduced efficacy, influenza vaccines containing an adjuvant to enhance immune response have been used in older adults in some European countries [8]. In the elderly and young children, there is emerging evidence that adjuvanted trivalent influenza vaccines (ATIV) result in enhanced protection against influenza infection or adverse outcomes following infection [9,10,11]. It has been proposed that these vaccines may provide protection against viral drift, thereby enhancing the duration of immunity against infection [12,13,14]
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