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An Assessment of the Expected Cost-Effectiveness of Quadrivalent Influenza Vaccines in Ontario, Canada Using a Static Model.

Chit A, Roiz J, Aballea S - PLoS ONE (2015)

Bottom Line: IIV4 is expected to achieve reductions in influenza-related morbidity and mortality compared to IIV3.Despite not accounting for herd protection, IIV4 is still expected to be a cost-effective alternative to IIV3 up to a price premium of 53%.Our conclusions were robust in the face of sensitivity analyses.

View Article: PubMed Central - PubMed

Affiliation: Health Outcomes and Economics-North America, Sanofi Pasteur, Toronto, Ontario, Canada; Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.

ABSTRACT
Ontario, Canada, immunizes against influenza using a trivalent inactivated influenza vaccine (IIV3) under a Universal Influenza Immunization Program (UIIP). The UIIP offers IIV3 free-of-charge to all Ontarians over 6 months of age. A newly approved quadrivalent inactivated influenza vaccine (IIV4) offers wider protection against influenza B disease. We explored the expected cost-utility and budget impact of replacing IIV3 with IIV4, within the context of Ontario's UIIP, using a probabilistic and static cost-utility model. Wherever possible, epidemiological and cost data were obtained from Ontario sources. Canadian or U.S. sources were used when Ontario data were not available. Vaccine efficacy for IIV3 was obtained from the literature. IIV4 efficacy was derived from meta-analysis of strain-specific vaccine efficacy. Conservatively, herd protection was not considered. In the base case, we used IIV3 and IIV4 prices of $5.5/dose and $7/dose, respectively. We conducted a sensitivity analysis on the price of IIV4, as well as standard univariate and multivariate statistical uncertainty analyses. Over a typical influenza season, relative to IIV3, IIV4 is expected to avert an additional 2,516 influenza cases, 1,683 influenza-associated medical visits, 27 influenza-associated hospitalizations, and 5 influenza-associated deaths. From a societal perspective, IIV4 would generate 76 more Quality Adjusted Life Years (QALYs) and a net societal budget impact of $4,784,112. The incremental cost effectiveness ratio for this comparison was $63,773/QALY. IIV4 remains cost-effective up to a 53% price premium over IIV3. A probabilistic sensitivity analysis showed that IIV4 was cost-effective with a probability of 65% for a threshold of $100,000/QALY gained. IIV4 is expected to achieve reductions in influenza-related morbidity and mortality compared to IIV3. Despite not accounting for herd protection, IIV4 is still expected to be a cost-effective alternative to IIV3 up to a price premium of 53%. Our conclusions were robust in the face of sensitivity analyses.

No MeSH data available.


Related in: MedlinePlus

Threshold analysis: Incremental cost-effectiveness ratio (ICER) versus price of IIV4.
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pone.0133606.g002: Threshold analysis: Incremental cost-effectiveness ratio (ICER) versus price of IIV4.

Mentions: The cost faced by firms due to influenza-related absenteeism is an influential parameter in the cost-effectiveness analysis. In Fig 1, we present a 1-way sensitivity analysis for the impact of the hourly labor cost on the ICER. Source data did not contain any statistical uncertainty estimates for the hourly labor cost; however, we did find two different estimates for the mean hourly labor costs in Canada. The figures reported by Statistics Canada were presented in the base case. In a scenario analysis, we used the hourly wage of $37/hour and found that this reduced the base case ICER to $47,489/QALY. Fig 2 shows how the ICER from the societal perspective varied as a function of the IIV4 price premium. IIV4 would be cost-neutral (more effective at the same cost) at a price of $6.10/dose, and the ICER would be $150,000/QALY at a price of $8.40/dose. Accordingly, IIV4 is dominant at a price premium of 11% and remains below $150,000/QALY–(the likely upper limit of a Canadian cost effectiveness threshold) up to a price premium of 53%.


An Assessment of the Expected Cost-Effectiveness of Quadrivalent Influenza Vaccines in Ontario, Canada Using a Static Model.

Chit A, Roiz J, Aballea S - PLoS ONE (2015)

Threshold analysis: Incremental cost-effectiveness ratio (ICER) versus price of IIV4.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4519190&req=5

pone.0133606.g002: Threshold analysis: Incremental cost-effectiveness ratio (ICER) versus price of IIV4.
Mentions: The cost faced by firms due to influenza-related absenteeism is an influential parameter in the cost-effectiveness analysis. In Fig 1, we present a 1-way sensitivity analysis for the impact of the hourly labor cost on the ICER. Source data did not contain any statistical uncertainty estimates for the hourly labor cost; however, we did find two different estimates for the mean hourly labor costs in Canada. The figures reported by Statistics Canada were presented in the base case. In a scenario analysis, we used the hourly wage of $37/hour and found that this reduced the base case ICER to $47,489/QALY. Fig 2 shows how the ICER from the societal perspective varied as a function of the IIV4 price premium. IIV4 would be cost-neutral (more effective at the same cost) at a price of $6.10/dose, and the ICER would be $150,000/QALY at a price of $8.40/dose. Accordingly, IIV4 is dominant at a price premium of 11% and remains below $150,000/QALY–(the likely upper limit of a Canadian cost effectiveness threshold) up to a price premium of 53%.

Bottom Line: IIV4 is expected to achieve reductions in influenza-related morbidity and mortality compared to IIV3.Despite not accounting for herd protection, IIV4 is still expected to be a cost-effective alternative to IIV3 up to a price premium of 53%.Our conclusions were robust in the face of sensitivity analyses.

View Article: PubMed Central - PubMed

Affiliation: Health Outcomes and Economics-North America, Sanofi Pasteur, Toronto, Ontario, Canada; Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.

ABSTRACT
Ontario, Canada, immunizes against influenza using a trivalent inactivated influenza vaccine (IIV3) under a Universal Influenza Immunization Program (UIIP). The UIIP offers IIV3 free-of-charge to all Ontarians over 6 months of age. A newly approved quadrivalent inactivated influenza vaccine (IIV4) offers wider protection against influenza B disease. We explored the expected cost-utility and budget impact of replacing IIV3 with IIV4, within the context of Ontario's UIIP, using a probabilistic and static cost-utility model. Wherever possible, epidemiological and cost data were obtained from Ontario sources. Canadian or U.S. sources were used when Ontario data were not available. Vaccine efficacy for IIV3 was obtained from the literature. IIV4 efficacy was derived from meta-analysis of strain-specific vaccine efficacy. Conservatively, herd protection was not considered. In the base case, we used IIV3 and IIV4 prices of $5.5/dose and $7/dose, respectively. We conducted a sensitivity analysis on the price of IIV4, as well as standard univariate and multivariate statistical uncertainty analyses. Over a typical influenza season, relative to IIV3, IIV4 is expected to avert an additional 2,516 influenza cases, 1,683 influenza-associated medical visits, 27 influenza-associated hospitalizations, and 5 influenza-associated deaths. From a societal perspective, IIV4 would generate 76 more Quality Adjusted Life Years (QALYs) and a net societal budget impact of $4,784,112. The incremental cost effectiveness ratio for this comparison was $63,773/QALY. IIV4 remains cost-effective up to a 53% price premium over IIV3. A probabilistic sensitivity analysis showed that IIV4 was cost-effective with a probability of 65% for a threshold of $100,000/QALY gained. IIV4 is expected to achieve reductions in influenza-related morbidity and mortality compared to IIV3. Despite not accounting for herd protection, IIV4 is still expected to be a cost-effective alternative to IIV3 up to a price premium of 53%. Our conclusions were robust in the face of sensitivity analyses.

No MeSH data available.


Related in: MedlinePlus