Urueña Analía, Micone Paula, Mould-Quevedo Joaquín, Saenz Carolina, Delgado Micaela, Montes José Luis, Giglio Norberto
Centro de Estudios para la Prevención y Control de Enfermedades Transmisibles (CEPyCET). Universidad ISalud, Buenos Aires, Argentina.
Hospital Carlos G Durand, Buenos Aires, Argentina.
Vaccine X. 2024 Nov 16;21:100587. doi: 10.1016/j.jvacx.2024.100587. eCollection 2024 Dec.
Enhanced influenza vaccines are the best option for the elderly. In 2021, Argentina introduced the MF59-adjuvanted inactivated influenza vaccine (aIIV) for individuals aged 65 years. and above, in the national immunization program. High dose inactivated influenza vaccine (HD-IIV) is also currently registered. This study evaluates the clinical and economic outcomes of these noted enhanced influenza vaccines for the elderly in Argentina.
Using a static decision-tree model and adopting the payer's perspective during an average influenza season, the analysis incorporated influenza epidemiological data from pre-pandemic Argentinian seasons (2014-2019), strain distribution, vaccination uptake, influenza-related costs and Quality-Adjusted Life-Years (QALYs) gained. Results include two relative vaccine effectiveness (rVE) scenarios from two published meta-analyses, due to reported rVE variability, although without statistical significance expected between enhanced vaccines. Vaccination acquisition costs were obtained from aIIV manufacturer, while HD-IIV costs were estimated using local (Argentinian private sector) and international public sector data (Europe). This assessment considered one GDP per-capita (US$13,696) as a cost-effectiveness threshold and included multiple sensitivity analysis.
With an expected lower vaccine cost and non-significant higher rVE for aIIV vs HD-IIV (3.2 %), aIIV generated 41.4 QALYs gained and US$8.7 M savings to the Argentinean public health system. In this scenario aIIV resulted as a dominant strategy over HD-IIV. On a second scenario, where HD-IIV has a non-significant higher rVE compared to aIIV (15.9 % and 13.9 % for HD-IIV and aIIV, respectively, both vs standard-dose IIV), HD-IIV would only result cost-effective compared to aIIV if its public price is up to 25 % the incremental cost in relation to the standard-dose IIV acquisition price.
In Argentina, the use of enhanced influenza vaccines in the elderly can increase vaccine effectiveness, reduce mortality and disease-related costs. Based on comparable effectiveness, the economic advantage of aIIV over HD-IIV confirms the current vaccination strategy employing aIIV in Argentina.
增强型流感疫苗是老年人的最佳选择。2021年，阿根廷在国家免疫规划中为65岁及以上人群引入了MF59佐剂灭活流感疫苗（aIIV）。高剂量灭活流感疫苗（HD-IIV）目前也已注册。本研究评估了这些著名的增强型流感疫苗在阿根廷老年人中的临床和经济效果。
使用静态决策树模型，并在一个平均流感季节中采用支付方的视角，分析纳入了大流行前阿根廷各季节（2014 - 2019年）的流感流行病学数据、毒株分布、疫苗接种率、流感相关成本以及获得的质量调整生命年（QALY）。由于已发表的两项荟萃分析报告的相对疫苗效力（rVE）存在差异，尽管预计增强型疫苗之间无统计学意义，但结果包括来自这两项荟萃分析的两种rVE情况。疫苗采购成本来自aIIV制造商，而HD-IIV成本使用当地（阿根廷私营部门）和国际公共部门数据（欧洲）进行估算。本评估将人均国内生产总值13,696美元作为成本效益阈值，并进行了多项敏感性分析。
预计aIIV的疫苗成本较低，与HD-IIV相比rVE略高（3.2%），aIIV为阿根廷公共卫生系统带来了获得的41.4个QALY和870万美元的节省。在这种情况下，aIIV成为优于HD-IIV 的主导策略。在第二种情况下，与aIIV相比HD-IIV的rVE略高（HD-IIV和aIIV分别为15.9%和13.9%，均相对于标准剂量IIV），只有当HD-IIV的公共价格高达相对于标准剂量IIV采购价格的增量成本的25%时，HD-IIV才会比aIIV具有成本效益。
在阿根廷，老年人使用增强型流感疫苗可提高疫苗效力，降低死亡率和疾病相关成本。基于可比效力，aIIV相对于HD-IIV的经济优势证实了阿根廷目前采用aIIV的疫苗接种策略。
