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Economic evaluation of adjuvanted and non-
adjuvanted flu vaccines in the elderly 65+Course Instructor: Chris SimmsPresenter: Srinivas Garlapati
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
