The cost-effectiveness of trivalent and quadrivalent influenza vaccination in communities in South Africa, Vietnam and Australia

Pieter T de Boer, Joel K Kelso, Nilimesh Halder, Thi-Phuong-Lan Nguyen, Jocelyn Moyes, Cheryl Cohen, Ian G Barr, Maarten J Postma, George J Milne

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Abstract

BACKGROUND: To inform national healthcare authorities whether quadrivalent influenza vaccines (QIVs) provide better value for money than trivalent influenza vaccines (TIVs), we assessed the cost-effectiveness of TIV and QIV in low-and-middle income communities based in South Africa and Vietnam and contrasted these findings with those from a high-income community in Australia.

METHODS: Individual based dynamic simulation models were interfaced with a health economic analysis model to estimate the cost-effectiveness of vaccinating 15% of the population with QIV or TIV in each community over the period 2003-2013. Vaccination was prioritized for HIV-infected individuals, before elderly aged 65+ years and young children. Country or region-specific data on influenza-strain circulation, clinical outcomes and costs were obtained from published sources. The societal perspective was used and outcomes were expressed in International$ (I$) per quality-adjusted life-year (QALY) gained.

RESULTS: When compared with TIV, we found that QIV would provide a greater reduction in influenza-related morbidity in communities in South Africa and Vietnam as compared with Australia. The incremental cost-effectiveness ratio of QIV versus TIV was estimated at I$4183/QALY in South Africa, I$1505/QALY in Vietnam and I$80,966/QALY in Australia.

CONCLUSIONS: The cost-effectiveness of QIV varied between communities due to differences in influenza epidemiology, comorbidities, and unit costs. Whether TIV or QIV is the most cost-effective alternative heavily depends on influenza B burden among subpopulations targeted forvaccination in addition to country-specific willingness-to-pay thresholds and budgetary impact.

Original languageEnglish
Pages (from-to)997-1007
Number of pages11
JournalVaccine
Volume36
Issue number7
Early online date17-Jan-2018
DOIs
Publication statusPublished - 8-Feb-2018

Keywords

  • Influenza
  • Cost-effectiveness
  • Vaccination
  • Trivalent
  • Quadrivalent
  • Dynamic transmission model
  • MIDDLE-INCOME COUNTRIES
  • PANDEMIC INFLUENZA
  • UNITED-STATES
  • VACCINES
  • SURVEILLANCE
  • EFFICACY
  • COHORT
  • EPIDEMIOLOGY
  • IMMUNIZATION
  • CHILDREN

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