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The potential cost-effectiveness of quadrivalent versus trivalent influenza vaccine in elderly people and clinical risk groups in the UK: a lifetime multi-cohort model.

Van Bellinghen LA, Meier G, Van Vlaenderen I - PLoS ONE (2014)

Bottom Line: To estimate the potential cost-effectiveness of quadrivalent influenza vaccine compared with trivalent influenza vaccine in the UK.Herd effect was not included.Quadrivalent 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.

View Article: PubMed Central - PubMed

Affiliation: CHESS, Ternat, Belgium.

ABSTRACT

Objective: To estimate the potential cost-effectiveness of quadrivalent influenza vaccine compared with trivalent influenza vaccine in the UK.

Methods: A 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%.

Results: Compared 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).

Conclusions: Quadrivalent 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.

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Related in: MedlinePlus

Multi-cohort approach.
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pone-0098437-g001: Multi-cohort approach.

Mentions: We constructed a static lifetime multi-cohort Markov model with a one-year cycle time, reflecting annual winter influenza seasons and applying the UK 2010 guidelines for interventions (vaccination, post-exposure prophylaxis (PEP) and/or antiviral treatment) [1], [27], [28]. Nine age groups were included (0–4, 5–17, 18–49, 50–64, 65–69, 70–74, 75–79, 80–84, ≥85 years), each subdivided into healthy and at-risk. Within the at-risk group we distinguished between those in a clinical risk group (who may receive PEP only if not effectively protected by vaccination) and those resident in long-term care facilities (who may receive PEP regardless of vaccination status). Clinical risk groups include patients with one or more of the following characteristics: chronic respiratory disease; chronic heart disease; chronic renal disease; chronic liver disease; chronic neurological conditions; diabetes mellitus; aged 65 years or older; immunosuppressed (including transplanted patients) [28]. Figure 1 provides a visual representation of the multi-cohort approach. At time zero, the total 2010 UK population is represented in the aforementioned 9 distinct age cohorts according to the UK population distribution [29]. The time horizon of the model was set at 100 years. Once an age cohort reaches the starting age of the next age cohort, the probabilities, costs and effects of the new age group are considered. The youngest age group, i.e. 0–4 years, is followed for a real 100 years while the cohort moves through all age groups. An older age group, for example, 70–74 years, is followed only for 30 years because all individuals within that cohort will have died after that period. Influenza A and B were accounted for separately, to allow the model to evaluate differences in vaccine protection.


The potential cost-effectiveness of quadrivalent versus trivalent influenza vaccine in elderly people and clinical risk groups in the UK: a lifetime multi-cohort model.

Van Bellinghen LA, Meier G, Van Vlaenderen I - PLoS ONE (2014)

Multi-cohort approach.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4048201&req=5

pone-0098437-g001: Multi-cohort approach.
Mentions: We constructed a static lifetime multi-cohort Markov model with a one-year cycle time, reflecting annual winter influenza seasons and applying the UK 2010 guidelines for interventions (vaccination, post-exposure prophylaxis (PEP) and/or antiviral treatment) [1], [27], [28]. Nine age groups were included (0–4, 5–17, 18–49, 50–64, 65–69, 70–74, 75–79, 80–84, ≥85 years), each subdivided into healthy and at-risk. Within the at-risk group we distinguished between those in a clinical risk group (who may receive PEP only if not effectively protected by vaccination) and those resident in long-term care facilities (who may receive PEP regardless of vaccination status). Clinical risk groups include patients with one or more of the following characteristics: chronic respiratory disease; chronic heart disease; chronic renal disease; chronic liver disease; chronic neurological conditions; diabetes mellitus; aged 65 years or older; immunosuppressed (including transplanted patients) [28]. Figure 1 provides a visual representation of the multi-cohort approach. At time zero, the total 2010 UK population is represented in the aforementioned 9 distinct age cohorts according to the UK population distribution [29]. The time horizon of the model was set at 100 years. Once an age cohort reaches the starting age of the next age cohort, the probabilities, costs and effects of the new age group are considered. The youngest age group, i.e. 0–4 years, is followed for a real 100 years while the cohort moves through all age groups. An older age group, for example, 70–74 years, is followed only for 30 years because all individuals within that cohort will have died after that period. Influenza A and B were accounted for separately, to allow the model to evaluate differences in vaccine protection.

Bottom Line: To estimate the potential cost-effectiveness of quadrivalent influenza vaccine compared with trivalent influenza vaccine in the UK.Herd effect was not included.Quadrivalent 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.

View Article: PubMed Central - PubMed

Affiliation: CHESS, Ternat, Belgium.

ABSTRACT

Objective: To estimate the potential cost-effectiveness of quadrivalent influenza vaccine compared with trivalent influenza vaccine in the UK.

Methods: A 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%.

Results: Compared 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).

Conclusions: Quadrivalent 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.

Show MeSH
Related in: MedlinePlus