Cost-Utility of Quadrivalent Versus Trivalent Influenza Vaccine in Germany, Using an Individual-Based Dynamic Transmission Model

Abstract

BackgroundSeasonal influenza infection is primarily caused by circulation of two influenza A strain subtypes and strains from two B lineages that vary each year. Trivalent influenza vaccine (TIV) contains only one of the two B-lineage strains, resulting in mismatches between vaccine strains and the predominant circulating B lineage. Quadrivalent influenza vaccine (QIV) includes both B-lineage strains. The objective was to estimate the cost-utility of introducing QIV to replace TIV in Germany.MethodsAn individual-based dynamic transmission model (4Flu) using German data was used to provide realistic estimates of the impact of TIV and QIV on age-specific influenza infections. Cases were linked to health and economic outcomes to calculate the cost-utility of QIV versus TIV, from both a societal and payer perspective. Costs and effects were discounted at 3.0 and 1.5 % respectively, with 2014 as the base year. Univariate and probabilistic sensitivity analyses were conducted.ResultsUsing QIV instead of TIV resulted in additional quality-adjusted life-years (QALYs) and cost savings from the societal perspective (i.e. it represents the dominant strategy) and an incremental cost-utility ratio (ICUR) of €14,461 per QALY from a healthcare payer perspective. In all univariate analyses, QIV remained cost-effective (ICUR <€50,000). In probabilistic sensitivity analyses, QIV was cost-effective in >98 and >99 % of the simulations from the societal and payer perspective, respectively.ConclusionThis analysis suggests that QIV in Germany would provide additional health gains while being cost-saving to society or costing €14,461 per QALY gained from the healthcare payer perspective, compared with TIV.Electronic supplementary materialThe online version of this article (doi:10.1007/s40273-016-0443-7) contains supplementary material, which is available to authorized users.

A systematic review of the health economic consequences of quadrivalent influenza vaccination

“…Of these 35 studies, 2 studies were excluded after screening titles and abstracts, and from 18 studies no full-text was available as these referred to conference abstracts only. As one additional study that met our inclusion criteria was identified outside the initial search, we ended up with 16 eligible studies [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. The flowchart of the study identification process is displayed in Figure 1.…”

“…A total of 13 out of 16 studies were ranked as good, adhering to more than 17 out of 24 items on the CHEERs checklist [20][21][22][23][24][25][26][28][29][30][31]33,35], while 3 studies were assessed as moderate, adhering to less than 17 out of 24 points [27,32,34]. Arguments for the choice of time-horizon and model-type were most often not reported.…”

“…A summary of the general study characteristics is given in [20,31], Spain [25], Finland [30], Australia [26], Germany [24], and Hong Kong [34,35]. One study analyzed the economic impact of QIV in 5 countries of the European Union (EU) and extrapolated this to all 27 EU countries [32].…”

“…Out of the 16 studies, 13 were funded by manufacturers [20][21][22][23][24][25][26][28][29][30][31][32][33], 1 was funded by public sources [27], and 2 studies were conducted without reporting any specific funding [34,35]. A total of 13 studies performed a cost-utility analysis [20][21][22][23][24][25][28][29][30][31][33][34][35], expressing results as costs per QALY gained. The remaining three studies conducted cost-comparisons [26,27,32].…”

“…Five studies used a dynamic modeling approach [23,24,[29][30][31]. For three of these five studies, a more detailed description of the dynamic model was previously published [37][38][39].…”