Sanofi, Lyon, France.
IQVIA, Zaventem, Belgium.
J Med Econ. 2023 Jan-Dec;26(1):710-719. doi: 10.1080/13696998.2023.2194193.
Seasonal influenza may result in severe outcomes, resulting in a significant increase of hospitalizations during the winter. To improve the protection provided by the standard dose influenza quadrivalent vaccine (SDQIV), a high-dose vaccine (HDQIV) has been developed specifically for adults aged 60 and older who are at higher risk of life-threatening complications.
The aim of this study was to determine the cost-effectiveness of HD QIV SD-QIV in the recommended population of three European countries: Belgium, Finland and Portugal.
A cost-utility analysis comparing HDQIV SDQIV was conducted using a decision tree estimating health outcomes conditional on influenza: cases, general practitioner and emergency department visits, hospitalizations and deaths. To account for the full benefit of the vaccine, an additional outcome-hospitalizations attributable to influenza-was also evaluated. Demographic, epidemiological and economic inputs were based on the respective local data. HDQIV relative vaccine efficacy SDQIV was obtained from a phase IV efficacy randomized clinical trial. The incremental cost-effectiveness ratios (ICER) were computed for each country, and a probabilistic sensitivity analysis (1,000 simulations per country) was performed to assess the robustness of the results.
In the base case analysis, HDQIV resulted in improved health outcomes (visits, hospitalizations, and deaths) compared to SDQIV. The ICERs computed were 1,397, 9,581, and 15,267 €/QALY, whereas the PSA yielded 100, 100, and 84% of simulations being cost-effective at their respective willingness-to-pay thresholds, for Belgium, Finland, and Portugal, respectively.
In three European countries with different healthcare systems, HD-QIV would contribute to a significant improvement in the prevention of influenza health outcomes while being cost-effective.
季节性流感可能导致严重后果，导致冬季住院人数显著增加。为了提高标准剂量流感四价疫苗（SDQIV）提供的保护，专门为 60 岁及以上、有发生危及生命并发症风险较高的成年人开发了高剂量疫苗（HDQIV）。
本研究旨在确定在比利时、芬兰和葡萄牙这三个欧洲国家推荐人群中使用 HD QIV 和 SD-QIV 的成本效益。
使用决策树比较了 HDQIV 和 SDQIV 的成本效用分析，该决策树根据流感情况估计了健康结果：病例、全科医生和急诊就诊、住院和死亡。为了充分考虑疫苗的全部效益，还评估了因流感导致的额外住院结果。人口统计学、流行病学和经济学投入基于各自的本地数据。HDQIV 相对于 SDQIV 的疫苗效力从一项四期疗效随机临床试验中获得。计算了每个国家的增量成本效益比（ICER），并对每个国家进行了 1,000 次模拟的概率敏感性分析，以评估结果的稳健性。
在基础案例分析中，与 SDQIV 相比，HDQIV 可改善健康结果（就诊、住院和死亡）。计算得出的 ICER 分别为 1,397、9,581 和 15,267 欧元/质量调整生命年，而 PSA 则分别在比利时、芬兰和葡萄牙的各自支付意愿阈值下，产生了 100%、100%和 84%的模拟结果是具有成本效益的。
在三个具有不同医疗保健系统的欧洲国家中，HD-QIV 将有助于显著改善流感健康结果，同时具有成本效益。
