标准剂量四价流感疫苗(QIV)旨在提供针对所有四种流感病毒株的保护。调整QIV(aQIV),适用于65岁以上的个人,结合MF59®佐剂(角鲨烯油的水包油乳液)与标准剂量的抗原,旨在产生更强、更长的免疫反应,尤其是在免疫衰老降低疫苗效力的老年人中。本研究评估了aQIV与aQIV的成本效益。老年人群中基于鸡蛋的标准剂量QIV(QIVe),从西班牙的付款人和社会角度来看。动态传输模型,这是保护群体的原因,用于预测西班牙医疗护理感染的数量。使用决策树结构来预测与流感相关的成本和收益。流感相关的门诊就诊概率,住院治疗,旷工,死亡率,以及相关的公用事业和成本是从西班牙和欧洲出版的文献中提取的。相对疫苗有效性(rVE)来自两个不同的荟萃分析:第一个荟萃分析仅由实验室确认的流感研究提供信息,结果rVE=34.6%(CI95%2-66%)赞成aQIV;第二个荟萃分析包括真实世界证据流感相关的医疗结果,导致aQIV获益的rVE=13.9%(CI95%4.2-23.5%)。所有费用均以2021欧元表示。结果表明,在西班牙老年人群中用aQIV代替QIVe将平均预防43,664例流感复杂病例,1111例住院,569例死亡(rVE=34.6%)或19,104例流感并发病例,486例住院,252例死亡(rVE=13.9%)。当aQIV的rVE与QIVe为34.6%,从付款人那里获得的每质量调整生命年(QALY)的增量成本为2240欧元;从社会角度来看,与QIVe相比,aQIV节省成本。如果rVE是13.9%,从付款人和社会的角度来看,每QALY的增量成本为6694欧元和3936欧元,分别。敏感性分析验证了这些发现的稳健性。结果表明,在西班牙老年人口中用aQIV代替QIVe是西班牙医疗保健系统的一种具有成本效益的策略。
Standard-dose quadrivalent influenza vaccines (QIV) are designed to provide protection against all four influenza strains. Adjuvanted QIV (aQIV), indicated for individuals aged 65+ years, combines MF59® adjuvant (an oil-in-water emulsion of squalene oil) with a standard dose of antigen, and is designed to produce stronger and longer immune response, especially in the elderly where immunosenescence reduces vaccine effectiveness. This study evaluated the cost-effectiveness of aQIV vs. egg-based standard-dose QIV (QIVe) in the elderly population, from the payer and societal perspective in Spain. A dynamic transmission model, which accounts for herd protection, was used to predict the number of medically attended infections in Spain. A decision tree structure was used to forecast influenza-related costs and benefits. Influenza-related probabilities of outpatient visit, hospitalization, work absenteeism, mortality, and associated utilities and costs were extracted from Spanish and European published literature. Relative vaccine effectiveness (rVE) was sourced from two different meta-analyses: the first meta-analysis was informed by laboratory-confirmed influenza studies only, resulting in a rVE = 34.6% (CI95% 2-66%) in favor of aQIV; the second meta-analysis included real world evidence influenza-related medical encounters outcomes, resulting in a rVE = 13.9% (CI95% 4.2-23.5%) in benefit of aQIV. All costs were expressed in 2021 euros. Results indicate that replacing QIVe with aQIV in the Spanish elderly population would prevent on average 43,664 influenza complicated cases, 1111 hospitalizations, and 569 deaths (with a rVE = 34.6%) or 19,104 influenza complicated cases, 486 hospitalizations, and 252 deaths (with a rVE = 13.9%). When the rVE of aQIV vs. QIVe is 34.6%, the incremental cost per quality adjusted life years (QALY) gained was €2240 from the payer; from the societal perspective, aQIV was cost saving compared with QIVe. If the rVE was 13.9%, the incremental cost per QALY was €6694 and €3936 from the payer and societal perspective, respectively. Sensitivity analyses validated the robustness of these findings. Results indicate that replacing QIVe with aQIV in the Spanish elderly population is a cost-effective strategy for the Spanish healthcare system.