Fochesato Anna, Sottile Sara, Pugliese Andrea, Márquez-Peláez Sergio, Toro-Diaz Hector, Gani Ray, Alvarez Piedad, Ruiz-Aragón Jesús
Department of Mathematics, University of Trento, Via Sommarive 14, 38123 Trento, Italy.
Fondazione The Microsoft Research-University of Trento, Centre for Computational and Systems Biology (COSBI), Piazza Manifattura 1, 38068 Rovereto, Italy.
Vaccines (Basel). 2022 Aug 20;10(8):1360. doi: 10.3390/vaccines10081360.
Standard-dose quadrivalent influenza vaccines (QIV) are designed to provide protection against all four influenza strains. Adjuvanted QIV (aQIV), indicated for individuals aged 65+ years, combines MF59 adjuvant (an oil-in-water emulsion of squalene oil) with a standard dose of antigen, and is designed to produce stronger and longer immune response, especially in the elderly where immunosenescence reduces vaccine effectiveness. This study evaluated the cost-effectiveness of aQIV vs. egg-based standard-dose QIV (QIVe) in the elderly population, from the payer and societal perspective in Spain. A dynamic transmission model, which accounts for herd protection, was used to predict the number of medically attended infections in Spain. A decision tree structure was used to forecast influenza-related costs and benefits. Influenza-related probabilities of outpatient visit, hospitalization, work absenteeism, mortality, and associated utilities and costs were extracted from Spanish and European published literature. Relative vaccine effectiveness (rVE) was sourced from two different meta-analyses: the first meta-analysis was informed by laboratory-confirmed influenza studies only, resulting in a rVE = 34.6% (CI95% 2-66%) in favor of aQIV; the second meta-analysis included real world evidence influenza-related medical encounters outcomes, resulting in a rVE = 13.9% (CI95% 4.2-23.5%) in benefit of aQIV. All costs were expressed in 2021 euros. Results indicate that replacing QIVe with aQIV in the Spanish elderly population would prevent on average 43,664 influenza complicated cases, 1111 hospitalizations, and 569 deaths (with a rVE = 34.6%) or 19,104 influenza complicated cases, 486 hospitalizations, and 252 deaths (with a rVE = 13.9%). When the rVE of aQIV vs. QIVe is 34.6%, the incremental cost per quality adjusted life years (QALY) gained was €2240 from the payer; from the societal perspective, aQIV was cost saving compared with QIVe. If the rVE was 13.9%, the incremental cost per QALY was €6694 and €3936 from the payer and societal perspective, respectively. Sensitivity analyses validated the robustness of these findings. Results indicate that replacing QIVe with aQIV in the Spanish elderly population is a cost-effective strategy for the Spanish healthcare system.
标准剂量四价流感疫苗（QIV）旨在预防所有四种流感毒株。用于65岁及以上人群的佐剂四价流感疫苗（aQIV）将MF59佐剂（一种角鲨烯油的水包油乳液）与标准剂量的抗原结合，旨在产生更强、更持久的免疫反应，尤其是在免疫衰老会降低疫苗效力的老年人中。本研究从西班牙医保支付方和社会角度评估了aQIV与基于鸡蛋的标准剂量四价流感疫苗（QIVe）在老年人群中的成本效益。使用一个考虑群体保护的动态传播模型来预测西班牙有医疗记录的感染病例数。采用决策树结构来预测流感相关的成本和效益。流感相关的门诊就诊、住院、旷工、死亡率以及相关效用和成本的概率取自西班牙和欧洲已发表的文献。相对疫苗效力（rVE）来自两项不同的荟萃分析：第一项荟萃分析仅基于实验室确诊的流感研究，结果显示支持aQIV的rVE = 34.6%（95%置信区间2 - 66%）；第二项荟萃分析纳入了与流感相关的医疗接触结果的真实世界证据，结果显示支持aQIV的rVE = 13.9%（95%置信区间4.2 - 23.5%）。所有成本均以2021年欧元表示。结果表明，在西班牙老年人群中用aQIV替代QIVe平均可预防43664例流感并发症病例、1111例住院病例和569例死亡（rVE = 34.6%），或19104例流感并发症病例、486例住院病例和252例死亡（rVE = 13.9%）。当aQIV相对于QIVe的rVE为34.6%时，医保支付方每获得一个质量调整生命年（QALY）的增量成本为2240欧元；从社会角度看，aQIV与QIVe相比节省成本。如果rVE为13.9%，医保支付方和社会角度每QALY的增量成本分别为6694欧元和3936欧元。敏感性分析验证了这些结果的稳健性。结果表明，在西班牙老年人群中用aQIV替代QIVe对西班牙医疗保健系统而言是一种具有成本效益的策略。
