Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an 710061, China; Shaanxi Center for Health Reform and Development Research, Xi'an 710061, China.
Department of Non-communicable Chronic Disease Control and Prevention, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an 710054, China.
Vaccine. 2020 Jan 29;38(5):1057-1064. doi: 10.1016/j.vaccine.2019.11.045. Epub 2019 Nov 29.
Influenza-associated excess death occurred most in the elderly. We aimed to assess the cost-effectiveness of quadrivalent influenza vaccine (QIV) versus trivalent influenza vaccine (TIV) for prevention of influenza infection among elderly population in China.
A decision-analytic model was developed to compare 1-year clinical and economic outcomes of three influenza vaccination options (no vaccination, TIV, and QIV) in a hypothetical cohort of Chinese elderly aged 69 years. Outcome measures included cost, influenza infection rate, influenza-related mortality rate, quality-adjusted life-years (QALY) loss, and incremental cost-effectiveness ratio (ICER) from societal perspective. Sensitivity analyses were performed to examine the uncertainty of model inputs.
Base-case results showed no vaccination was dominated (more costly at higher QALY loss) by TIV and QIV. QIV was more costly (USD56.29 versus USD54.28) with lower influenza infection rate (0.608 versus 0.623), mortality rate (0.00199 versus 0.00204), and QALY loss (0.01213 versus 0.01243) than TIV. QIV was cost-effective compared to TIV with ICER of 6,700 USD/QALY below the willingness-to-pay threshold (29,580 USD/QALY). One-way sensitivity analysis found the cost-effectiveness of QIV was subject to the relative risk of vaccine effectiveness of QIV versus TIV, and TIV would be cost-effective if the relative risk was below 1.05. In 10,000 Monte Carlo simulations, the probabilities of QIV, TIV, and no vaccination to be cost-effective were 86.3%, 13.7%, and 0%, respectively.
QIV appears to be a cost-effective option compared to TIV and no influenza vaccination for elderly population in China.
流感相关超额死亡主要发生在老年人中。本研究旨在评估在中国老年人中，四价流感疫苗（QIV）与三价流感疫苗（TIV）预防流感感染的成本效益。
建立了一个决策分析模型，以比较三种流感疫苗接种方案（不接种、TIV 和 QIV）在一个中国 69 岁老年人假设队列中的 1 年临床和经济结局。结局指标包括成本、流感感染率、流感相关死亡率、质量调整生命年（QALY）损失和增量成本效益比（ICER）。从社会角度进行敏感性分析以检验模型输入的不确定性。
基础情况分析结果显示，TIV 和 QIV 均优于不接种疫苗（成本更高，QALY 损失更大）。QIV 比 TIV 更昂贵（56.29 美元对 54.28 美元），流感感染率（0.608 对 0.623）、死亡率（0.00199 对 0.00204）和 QALY 损失（0.01213 对 0.01243）更低。与 TIV 相比，QIV 的 ICER 为 6700 美元/QALY，低于意愿支付阈值（29580 美元/QALY），因此具有成本效益。单因素敏感性分析发现，QIV 的成本效益取决于 QIV 相对于 TIV 的疫苗效力的相对风险，如果相对风险低于 1.05，TIV 则具有成本效益。在 10000 次蒙特卡罗模拟中，QIV、TIV 和不接种疫苗具有成本效益的概率分别为 86.3%、13.7%和 0%。
与 TIV 和不接种流感疫苗相比，QIV 似乎是中国老年人群的一种具有成本效益的选择。
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