Abstract
ObjectiveTo estimate the potential cost-effectiveness of quadrivalent influenza vaccine compared with trivalent influenza vaccine in the UK.MethodsA lifetime, multi-cohort, static Markov model was constructed, with nine age groups each divided into healthy and at-risk categories. Influenza A and B were accounted for separately. The model was run in one-year cycles for a lifetime (maximum age: 100 years). The analysis was from the perspective of the UK National Health Service. Costs and benefits were discounted at 3.5%. 2010 UK vaccination policy (vaccination of people at risk and those aged ≥65 years) was applied. Herd effect was not included. Inputs were derived from national databases and published sources where possible. The quadrivalent influenza vaccine price was not available when the study was conducted. It was estimated at £6.72,15% above the trivalent vaccine price of £5.85. Sensitivity analyses used an incremental price of up to 50%.ResultsCompared with trivalent influenza vaccine, the quadrivalent influenza vaccine would be expected to reduce the numbers of influenza cases by 1,393,720, medical visits by 439,852 complications by 167,357, hospitalisations for complications by 26,424 and influenza deaths by 16,471. The estimated base case incremental cost-effectiveness ratio (ICER) was £5,299/quality-adjusted life-year (QALY). Sensitivity analyses indicated that the ICER was sensitive to changes in circulation of influenza virus subtypes and vaccine mismatch; all other parameters had little effect. In 96% of simulations the ICER was <£20,000/QALY. Since this analysis was completed, quadrivalent influenza vaccine has become available in the UK at a list price of £9.94. Using this price in the model, the estimated ICER for quadrivalent compared with trivalent vaccination was £27,378/QALY, still within the NICE cost-effectiveness threshold (£20,000-£30,000).ConclusionsQuadrivalent influenza vaccine could reduce influenza disease burden and would be cost-effective compared with trivalent influenza vaccine in elderly people and clinical risk groups in the UK.
Highlights
Influenza is a highly infectious acute viral illness
As more people survive with quadrivalent vaccination, there are more people in the quadrivalent vaccine group than the trivalent vaccine group who are at risk of influenza infection and may receive PEP and/or vaccination in each successive influenza season
The model accumulates these data over the lifetime of the multi-cohort, and so the cumulative number of vaccinations and PEP treatments is higher with quadrivalent vaccination
Summary
Influenza is a highly infectious acute viral illness. In healthy individuals influenza is generally self-limiting, but complications such as pneumonia may cause serious illness [1]. Children aged , 6 months, elderly people (aged $65 years), and individuals with conditions such as chronic respiratory or heart disease have an increased risk of influenza complications and serious illness, compared with the general population [1]. The clinical and economic burden of influenza is substantial, estimated at 779,000– 1,164,000 general practitioner (GP) consultations, 19,000–31,200 hospital admissions and 18,500–24,800 deaths annually in the UK [2]. There are three types of influenza virus: A, B and C. Influenza A and influenza B are responsible for most clinical illness. Each can be further subdivided into different subtypes [1]
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