This review was undertaken to consolidate information on the epidemiology and burden of influenza B, as well as the circulation patterns of influenza B lineage in 9 European countries. Following a comprehensive search of peer-reviewed and gray literature sources, we found that published data on influenza B epidemiology and burden are scarce. Surveillance data show frequent co-circulation of both influenza B lineages during influenza seasons, but little is known about its impact, especially in adults and the clinical burden of influenza B remains unknown. Mismatch between the circulating influenza B lineage and vaccine recommendations has been seen in at least one influenza season in every country. Such observations could impact the effectiveness of seasonal influenza vaccination programs using trivalent vaccines, which contain only one influenza B lineage (B/Yamagata or B/Victoria) and highlight the need for local studies to better understand the epidemiology and burden of influenza B in these countries.

Background:The optimisation of vaccine policies before their implementation is beholden upon public health decision makers, seeking to maximise population health. In this case study in Serbia, the childhood vaccines under consideration included pneumococcal conjugate vaccination (PCV), rotavirus (RV) vaccination and varicella zoster virus (VZV) vaccination. Objective: The objective of this study is to define the optimal order of introduction of vaccines to minimise deaths, quality adjusted life years (QALYs) lost, or hospitalisation days, under budget and vaccine coverage constraints. Methods: A constrained optimisation model was developed including a static multi-cohort decision-tree model for the three infectious diseases. Budget and vaccine coverage were constrained, and to rank the vaccines, the optimal solution to the linear programming problem was based upon the ratio of the outcome (deaths, QALYs or hospitalisation days) per unit of budget. A probabilistic decision analysis Monte Carlo simulation technique was used to test the robustness of the rankings. Results: PCV was the vaccine ranked first to minimise deaths, VZV vaccination for QALY loss minimisation and RV vaccination for hospitalisation day reduction. Sensitivity analysis demonstrated the most robust ranking was that for PCV minimizing deaths. Conclusion: Constrained optimisation modelling, whilst considering all potential interventions currently, provided a comprehensive and rational approach to decision making.

to inform the model. Both alternatives were compared. A one-way sensitivity analysis was performed to find the parameters with the biggest impact on ICER, and a probabilistic sensitivity analysis allowed to evaluate the robustness of the base case results. Results: By switching from TIV to QIV, the model estimated that about 37 confirmed influenza cases, five hospitalizations and one death could have been averted in the 2015/16 season in the elderly, resulting in a cost-saving of 20,695V. However, the higher cost of QIV would lead to a total increment of 2,848,924V and the resulting ICER would be 14,242,844V/QALY, largely above the usual cost-effectiveness thresholds. PSA results reinforced the base case conclusions, with an 95% interval estimate of (7,047,221; 46,191,560) for ICER, also not including the usual acceptable values. One-Way Sensitivity Analysis (OWSA) allowed to find the disutility associated with ILI when no confirmed influenza and the cost of quadrivalent vaccine as the parameters most sensitive for ICER. Conclusions: From the NHS, this study concluded that QIV is not cost-effective for the elderly population.

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Objectives: The ACTG 5257 clinical trial showed that raltegravir (RAL) was superior to atazanavir/ritonavir (ATV/r) and darunavir/ritonavir (DRV/r), when used in combination with tenofovir DF/emtricitabine (TDF/FTC), in a 96-week composite endpoint combining virologic efficacy and tolerability for treatment-naive adults with HIV-1 infection. This study aimed to estimate costs and efficiency associated with these three regimens in Spain. MethOds: An economic model was developed to estimate costs for antiretroviral drugs, adverse event management, and HIV care for individuals initiating first-line therapy. Head-to-head efficacy and safety data (discontinuation rates based on the trial's composite endpoint, mean CD4+ cell-count changes, adverse event incidence) up to 96 weeks for RAL, ATV/r, and DRV/r were obtained from the ACTG 5257 clinical trial. Antiretroviral drug costs were based on hospital costs with additional mandatory discounts applied. Adverse event management costs and HIV care costs, stratified by CD4+ cell-count range, were obtained from published sources and inflated to 2015 euros. Costs per successfully treated patient (i.e., remaining on first-line therapy for 96 weeks) were estimated for the three regimens and tested in sensitivity and scenario analyses. All outcomes were discounted at 3.0% per year. Results: At 96 weeks, RAL was associated with higher antiretroviral drug costs, lower adverse event costs, and similar HIV care costs when compared with either ATV/r or DRV/r. Total costs per successfully treated patient were € 22,377 for RAL, € 26,629 for ATV/r, and € 23,928 for DRV/r. These results were found to be robust in probabilistic sensitivity and scenario analyses. cOnclusiOns: RAL has the lowest cost per successfully treated patient when compared with two other common first-line regimens, DRV/r and ATV/r, each used in combination with TDF/FTC, for treatment-naive adults with HIV-1 infection in Spain. This economic evidence further complements the known clinical benefits of RAL as reported in the ACTG 5257 clinical trial.