Adjuvanted influenza vaccines are cost-effective in the elderly aged 65+

Economic evaluation of adjuvanted and non-

adjuvanted flu vaccines in the elderly 65+Course Instructor: Chris SimmsPresenter: Srinivas Garlapati

Influenza and it’s Control

Review of literature

The Cochrane Collaboration revealed that the best effectiveness for vaccination for influenza-related complications is for persons in long-term care facilities, and the worst for those in community-dwelling people

Review of literature (2)

“Any conclusions regarding the effects of influenza vaccines for people aged 65 years or older cannot be drawn” because of the poor quality of evidence (Jefferson et al 2009).

Review of literature (3)

Medline search for reports between 2009-2012, with the search terms “elderly”, “65 years”, “seasonal”, “influenza”, and “vaccine” identified no studies of efficacy or effectiveness estimates of seasonal flu vaccines

Drawbacks of current studies

Few studies in elderly

Data of poor quality

Cochrane review: 75 studies, of which only five were RCTs

Most RCTs conducted on frail institutionalized elders

No RCTs in community settings

Vaccine EfficacyTIV

<6 Y 0.5 (0-0.83)6-64 Y 0.9 (0.7-0.9)>64 Y 0.2 (0-0.2)

ATIV6-64 Y 0.9 (0-0.9)>64 Y 0.4 (0.2-0.4)

Study parameters• Largest RCT comparing non adjuvanted (TIV) and

Adjuvanted (ATIV)

• Study done in 15 countries including Canada

• The first efficacy estimate in elderly population

• Study was done in 43,802 participants

• Randomized into two groups (TIV v/s ATIV)

• Study done in community settings

• ATIV compared against current standard of care

• Study done over two year period

• Participants followed by telephone, home and site visits

• Samples collected in patients showing flu symptoms

Results

ATIV demonstrated higher efficacy in reducing infections but was not significant statistically

ATIV was efficacious in reducing the number of cases of pneumonia, hospital admissions, and deaths

ATIV was effective against Influenza A virus infections

No Economic evaluation

Figure 2. Projected health benefits of using adjuvanted influenza vaccine.

Fisman DN, Tuite AR (2011) Estimation of the Health Impact and Cost-Effectiveness of Influenza Vaccination with Enhanced Effectiveness in Canada. PLoS ONE 6(11): e27420. doi:10.1371/journal.pone.0027420http://www.plosone.org/article/info:doi/10.1371/journal.pone.0027420

Results

The use of Adjuvanted flu vaccine was highly cost effective in the elderly

ICER = $2111/QALY gained

Use of ATIV instead of TIV confers benefit to both vaccinated and unvaccinated people

Projections were robust with wide ranging sensitivity analysis

Cost effectiveness analysis of Adjuvanted Flu Vaccination

in the elderly using

Decision Tree Analysis

Steps in decision tree analysis

Define the problem

Structure the decision and make a tree

Fill in the probabilities and the corresponding health outcomes

Conduct cost-effectiveness analysis

Interpret results

Steps in decision tree analysis

Define the problem

Structure the decision and make a tree

Fill in the probabilities and the corresponding health outcomes

Conduct cost-effectiveness analysis

Interpret results

No va

ccin

e

TIV

ATIV

No va

ccin

e

TIV

ATIV

Protected

Infections

Complications

Protected

Infections

Complications

Protected

Infections

Complications

Infections

Complications

Infections

Infections

Complications

Complications

Protected

Protected

Protected

0.0

0.70.3

0.2

0.25

0.55

0.4

0.125

0.475

$0

$0

$0

$50

$50

$50

$3587

$3587

$3587

No va

ccin

e

TIV

ATIV

$0

$7.5

$12.59

Expected Costs:

No vaccine = $0 + 0.0 X 0 + 0.7 X 50 + 0.3 X 3587 = $1111

TIV = $7.5 + 0.2 X 0 + 0.55 X 50 + 0.25 X 3587 = $ 931

ATIV = $12.59 + 0.4 X 0 + 0.475 X 50 + 0.125 X 3587 = $ 484

No vaccine = $0 + 0.0 X 0 + 0.7 X 50 + 0.3 X 3587 = $1111

TIV = $7.5 + 0.2 X 0 + 0.55 X 50 + 0.25 X 3587 = $ 931

ATIV = $12.59 + 0.4 X 0 + 0.475 X 50 + 0.125 X 3587 = $ 484

Cost effective analysis

= (1111-931)/(7.5-0) = 24

=(1111-484)/(12.59-0) =49.8=(931-484)/(12.59-7.5)

=87.6

‘Drummond’ checklist1. Was a well-defined question posed in answerable form?

2. Was a comprehensive description of alternatives given?

3. Was there evidence that effectiveness had been established?

4. Were all the important and relevant costs and consequences for each alternative identified?

5. Were costs and consequences measured accurately/appropriately?

6. Were costs and consequences valued credibly?

7. Were costs and consequences adjusted for differential timing?

8. Was an incremental analysis performed?

9. Was allowance made for uncertainty?

10. Did presentation/discussion of results include all issues of concern?

Conclusions and recommendations

Adjuvanted vaccines are more effective

Replacement of current vaccines with adjuvanted vaccines is economically viable

Need for development of more efficacious vaccines