Economic assessment of a high-dose versus a standard-dose influenza vaccine in the US Veteran population: Estimating the impact on hospitalization cost for cardio-respiratory disease

The challenges and benefits of public health in smart cities from a 4 M perspective

Introduction

With the acceleration of urbanization, public health issues have become increasingly prominent in smart city construction, especially in the face of sudden public health crises. A deep research method for public health management based on a 4M perspective (human, machine, materials, methods) is proposed to effectively address these challenges. Methods: The method involves studying the impact of human factors such as population age, gender, and occupation on public health from a human perspective. It incorporates a machine perspective by constructing a public health prediction model using deep neural networks. Additionally, it analyzes resource allocation and process optimization in public health management from the materials and methods perspectives.

Results

The experiments demonstrate that the public health prediction model based on deep neural networks achieved a prediction accuracy of 98.6% and a recall rate of 97.5% on the test dataset. In terms of resource allocation and process optimization, reasonable adjustments and optimizations increased the coverage of public health services by 20% and decreased the response time to public health events by 30%.

Discussion

This research method has significant benefits for addressing the challenges of public health in smart cities. It can improve the efficiency and effectiveness of public health services, helping smart cities respond more quickly and accurately to potential large-scale public health events in the future. This approach holds important theoretical and practical significance.

Cost-effectiveness of high-dose quadrivalent influenza vaccine versus standard-dose quadrivalent influenza vaccine for older people in a country with high influenza vaccination rate

The highdose quadrivalent influenza vaccine (QIVHD) has shown improved protection against influenza and its complications in older adults. We aimed to evaluate the costeffectiveness of QIVHD compared with QIVSD among Korean adults aged ≥ 65 years in reducing influenzarelated disease burden. We evaluated the 2016/2017 and 2017/2018 seasons and their average values using a static decision tree model. The difference in efficacy between standard-dose (SD) and high-dose (HD) was calculated based on the results of a clinical trial comparing Fluzone® High-Dose Vaccine and Fluzone® Vaccine in older adults. Incremental cost-effectiveness ratios (ICERs) were assessed from the healthcare system perspective. A discount rate of 4.5% was applied to life-year-gained (LYG) values and utilities. We performed deterministic and probabilistic sensitivity analyses to account for both epidemiological and economic sources of uncertainty. In the analysis of the 2017/2018 season, the QIV-HD strategy generated an excess of 0.00182 life-years (Lys)/person and 0.003953 quality-adjusted life-years (QALYs)/person compared with QIV-SD. The ICER was 6,467.56 United States Dollars (USD)/QALY. In the analysis from the 2016/2017 season, QIV-HD caused a surplus of 0.00117 Lys/person and 0.003272 QALYs/person compared with QIV-SD. ICER was 7,902.46 USD /QALY. From the average data of the 2016/2017 and 2017/2018 seasons, an excess of 0.00147 Lys/person and 0.003561 QALYs/person were generated using QIV-HD compared with QIV-SD, while the ICER was 7,190.44 USD /QALY. From the healthcare system perspective, QIV-HD was a more cost-effective vaccination option in reducing influenza-related disease burden and healthcare costs in Koreans aged ≥ 65 years compared with QIV-SD.

Reducing Hospital Capacity Needs for Seasonal Respiratory Infections: The Case of Switching to High-Dose Influenza Vaccine for Dutch Older Adults

OBJECTIVES

Influenza is responsible for considerable health and economic burden every year. Especially older adults are vulnerable for influenza infection and its complications due to immunosenescence and often-underlying medical conditions. Recently, the innovative quadrivalent high-dose influenza vaccine (QIV-HD) has become available in Europe. Through its enhanced immunogenicity, QIV-HD offers improved protection for older adults against respiratory as well as cardiovascular complications. We estimated the potential impact-specifically in terms of hospital admissions and related costs-of a hypothetical past switch from QIV-Standard dose (SD) to QIV-HD in The Netherlands.

METHODS

Estimates of hospitalizations for the older adults vaccinated with QIV-SD were derived from the seasons 2010/2011-2017/2018. Subsequently, the number of respiratory infections and cardiovascular complications of influenza were estimated for the year 2019/2020 for both QIV-SD and QIV-HD. To calculate the overall corresponding savings, costs for hospital complications, derived from literature, were used.

RESULTS

When QIV-HD would have been used instead of QIV-SD during the season 2019/2020, an additional 220 hospitalizations would have been averted among older adults of 60 years and older in the Netherlands. This corresponds to savings of €1 219 779 (uncertainty interval: 1 089 813-1 348 549), of which 69% is attributable to cardiovascular-related hospitalizations.

CONCLUSIONS

We demonstrate that a relevant improvement in influenza vaccination among older adults in The Netherlands can be achieved by switching from the current QIV-SD to QIV-HD. Not only comes a switch from QIV-SD to QIV-HD with a significant reduction in pressure on hospital capacity but also with notable cost savings.

Cost-effectiveness of influenza vaccination with a high dose quadrivalent vaccine of the elderly population in Belgium, Finland, and Portugal

BACKGROUND

Seasonal influenza may result in severe outcomes, resulting in a significant increase of hospitalizations during the winter. To improve the protection provided by the standard dose influenza quadrivalent vaccine (SDQIV), a high-dose vaccine (HDQIV) has been developed specifically for adults aged 60 and older who are at higher risk of life-threatening complications.

OBJECTIVES

The aim of this study was to determine the cost-effectiveness of HD QIV vs. SD-QIV in the recommended population of three European countries: Belgium, Finland and Portugal.

METHODS

A cost-utility analysis comparing HDQIV vs. SDQIV was conducted using a decision tree estimating health outcomes conditional on influenza: cases, general practitioner and emergency department visits, hospitalizations and deaths. To account for the full benefit of the vaccine, an additional outcome-hospitalizations attributable to influenza-was also evaluated. Demographic, epidemiological and economic inputs were based on the respective local data. HDQIV relative vaccine efficacy vs. SDQIV was obtained from a phase IV efficacy randomized clinical trial. The incremental cost-effectiveness ratios (ICER) were computed for each country, and a probabilistic sensitivity analysis (1,000 simulations per country) was performed to assess the robustness of the results.

RESULTS

In the base case analysis, HDQIV resulted in improved health outcomes (visits, hospitalizations, and deaths) compared to SDQIV. The ICERs computed were 1,397, 9,581, and 15,267 €/QALY, whereas the PSA yielded 100, 100, and 84% of simulations being cost-effective at their respective willingness-to-pay thresholds, for Belgium, Finland, and Portugal, respectively.

CONCLUSION

In three European countries with different healthcare systems, HD-QIV would contribute to a significant improvement in the prevention of influenza health outcomes while being cost-effective.

Systematic Review on the Cost-Effectiveness of Seasonal Influenza Vaccines in Older Adults

OBJECTIVES

Older adults are at high risk of influenza-related complications or hospitalization. The purpose of this systematic review is to assess the relative cost-effectiveness of all influenza vaccine options for older adults.

METHODS

This systematic review identified economic evaluation studies assessing the cost-effectiveness of influenza vaccines in adults ≥65 years of age from 5 literature databases. Two reviewers independently selected, extracted, and appraised relevant studies using the JBI Critical Appraisal Checklist for Economic Evaluations and Heyland's generalizability checklist. Costs were converted to 2019 Canadian dollars and adjusted for inflation and purchasing power parity.

RESULTS

A total of 27 studies were included. There were 18 comparisons of quadrivalent inactivated vaccine (QIV) versus trivalent inactivated vaccine (TIV): 5 showed QIV dominated TIV (ie, lower costs and higher health benefit), and 13 showed the results depended on willingness to pay (WTP). There were 9 comparisons of high-dose TIV (TIV-HD) versus TIV: 5 showed TIV-HD dominated TIV, and 4 showed the results depended on WTP. There were 8 comparisons of adjuvanted TIV (TIV-ADJ) versus TIV: 4 showed TIV-ADJ dominated TIV, and 4 showed the results depended on WTP. There were few pairwise comparisons among QIV, TIV-HD, and TIV-ADJ.

CONCLUSIONS

The evidence suggests QIV, TIV-HD, and TIV-ADJ are cost-effective against TIV for a WTP threshold of $50 000 per quality-adjusted life-year. Future studies should include new and existing vaccine options for broad age ranges and use more robust methodologies-such as real-world evaluations or modeling studies accounting for methodological, structural, and parameter uncertainty.

Economic Assessment of High-Dose Versus Adjuvanted Influenza Vaccine: An Evaluation of Hospitalization Costs Based on a Cohort Study

Two influenza vaccines are licensed in the U.S. exclusively for the 65 years and older population: a trivalent inactivated high-dose influenza vaccine (HD-IIV3) and a trivalent inactivated adjuvanted influenza vaccine (aIIV3). In a recent publication, we estimated a relative vaccine effectiveness (rVE) of HD-IIV3 vs. aIIV3 of 12% (95% CI: 3.3–20%) for influenza-related hospitalizations using a retrospective study design, but did not report the number of prevented hospitalizations nor the associated avoided cost. In this paper we report estimations for both. Methods: Leveraging the rVE of a cohort study over two influenza seasons (2016/17 and 2017/18), we collected cost data for healthcare provided to the same study population. Vaccine costs were obtained from the Medicare pricing schedule. Our economic assessment compared cost of vaccination and hospital care for patients experiencing acute respiratory or cardiovascular illness. Results: We analyzed 1.9 million HD-IIV3 and 223,793 aIIV3 recipients. Average vaccine list prices were $46.23 for HD-IIV3 and $48.26 for aIIV3. The hospitalization rates for respiratory disease in HD-IIV3 and aIIV3 recipients were 187 (95% CI: 185–189) and 212 (195–231) per 10,000 persons-years, respectively. Attributing the average cost per hospitalization of $12,652 ($12,214–$13,090) to the difference in hospitalization rates, we estimate net savings of HD-IIV3 to be $34 ($10–$62) per recipient. Conclusion: Pooled over two predominantly A/H3N2 respiratory seasons, vaccination with HD-IIV3 was associated with lower hospitalization rates and associated costs compared to aIIV3 in senior members of a large national managed health care company in the U.S. Reduced hospitalizations affect healthcare utilization overall, and therefore other costly health outcomes.

Analisi di costo-efficacia e budget impact per il vaccino antinfluenzale quadrivalente ad alto dosaggio nella popolazione anziana italiana

Introduction:

Influenza is a widespread acute respiratory disease and represents a serious Public Health problem, both from the NHS and society perspectives. The High Dose quadrivalent influenza vaccine (QIV HD) is a flu vaccine containing 4 times the antigens of a Standard Dose vaccine, resulting in demonstrated superior protection in the population aged 65 years and over.

Methods:

The analysis has been conducted from the perspective of the NHS. The CEA focuses on the comparison between QIV HD and the QIV SD vaccine. The BIM aims to estimate the potential economic impact for the National Health Service (NHS) resulting from the use of QIV HD in clinical practice in subjects aged 65 or over, when considering its introduction in combination with currently used vaccines, QIV SD and adjuvanted TIV.

Results:

In a scenario which considers hospitalizations possibly related to influenza, so including cardio-respiratory events, a dominant cost-effectiveness profile emerges in the comparison with QIV SD. In terms of budget impact, overall savings obtained by comparing the two scenarios regarding hospitalizations are equal to 92,766,429 € over the three years’ time horizon considered in the analysis.

Conclusions:

Nowadays, also considering the state of emergency due to the spread of the SARS-CoV-2 virus, it is crucial to implement innovative health technologies that improve the efficiency and sustainability of the health system. Also, it is essential to protect the elderly population, helping to avoid overload and healthcare systems disruption due to the many COVID-19 hospitalizations.

Cost-utility analysis of influenza vaccination in a population aged 65 years or older in Spain with a high-dose vaccine versus an adjuvanted vaccine

BACKGROUND

The normal ageing process is accompanied by immunosenescence and a progressive weakening of the immune system. High-dose inactivated influenza quadrivalent vaccine (HD-QIV) has shown greater immunogenicity, relative efficacy, and effectiveness than the standard-dose inactivated quadrivalent vaccine (SD-QIV). The aim of the study was to assess the cost-utility of an HD-QIV strategy compared with an adjuvanted trivalent inactivated vaccine (aTIV) strategy in the population above 65 years of age in Spain.

METHODS

We evaluated the public health and economic benefits of alternatives by using a decision-tree model, which included influenza cases, visits to the general practitioner (GP), visits to the emergency department (ED), hospitalisations, and mortality related to influenza. We performed deterministic and probabilistic sensitivity analyses to account for both epidemiological and economical sources of uncertainty.

RESULTS

Our results show that switching from aTIV strategy to HD-QIV would prevent 36,476 cases of influenza, 5,143 visits to GP, 1,054 visits to the ED, 9,193 episodes of hospitalisation due to influenza or pneumonia, and 357 deaths due to influenza - increasing 3,514 life-years and 3,167 quality-adjusted life-years (QALYs). Healthcare costs increase by €78,874,301, leading to an incremental cost-effectiveness ratio (ICER) of €24,353/QALY. The sensitivity analysis indicates that the results are rather robust.

CONCLUSION

Our analysis shows that HD-QIV in people over 65 years of age is an influenza-prevention strategy that is at least cost-effective, if not dominant, in Spain. It reduces cases of influenza, GP visits, hospitalisations, deaths, and associated healthcare costs.

Economic evaluation of high-dose inactivated influenza vaccine in adults aged ≥65 years: A systematic literature review

INTRODUCTION

Due to waning immunity, adults aged ≥65 years are at increased risk of seasonal influenza infection and its complications. Adding to this risk, older adults have reduced responses to influenza vaccines. A high-dose trivalent inactivated influenza vaccine (Fluzone High-Dose, Sanofi Pasteur) (IIV3-HD) was developed to improve protection against influenza in adults aged ≥65 years and has been licensed in the US since 2009 and in Canada since 2015. Post-licensure studies have shown that IIV3-HD is more effective than standard-dose trivalent inactivated influenza vaccine (IIV3-SD) at protecting against influenza infection in this population. Here, we performed a systematic review of economic analyses of IIV3-HD in adults aged ≥65 years.

METHODS

On June 9, 2019, using the Ovid search platform, we searched Econlit, Embase, and Ovid MEDLINE® for original studies published in peer-reviewed journals examining the economics or cost-effectiveness of IIV3-HD in adults aged ≥65 years. Two reviewers independently selected studies and assessed their quality.

RESULTS

Seven studies were selected, all performed in the US or Canada. Five studies were funded by IIV3-HD manufacturer, and the remaining two by the US National Institute of General Medical Sciences. In all studies, IIV3-HD reduces healthcare resource utilization and is cost-effective or cost-saving compared to IIV3-SD. The main driver is reduced hospitalizations for cardiorespiratory events.

CONCLUSION

IIV3-HD is cost-saving or cost-effective versus IIV3-SD in adults aged ≥65 years. Reduced cardiorespiratory complications are an important driver of these economic benefits. A video summary of the article can be accessed via the Supplementary data link at the end of this article.

Estimating public health and economic benefits along 10 years of Fluzone® High Dose in the United States

OBJECTIVE

The objective of this study was to estimate the public health and economic benefits (from a Medicare perspective) of Fluzone High-Dose® in the US elderly population, since its introduction in 2010.

METHODS

A budget impact model was developed using a decision tree framework and applied over 9 influenza seasons (2010/11 to 2018/19). The decision tree model was designed to capture influenza cases, hospitalizations possibly related to influenza or laboratory confirmed influenza, and influenza-related deaths. The analysis included influenza vaccines recommended by ACIP since 2010: SD TIV (trivalent), SD QIV (quadrivalent), HD TIV, aTIV (adjuvanted), ccQIV (cell-cultured). Two strategies were compared to evaluate the impact of HD TIV: a 'with HD TIV' strategy representative of the US vaccine landscape, and a 'without HD TIV' where the absence of HD TIV was modelled. Clinical and economic inputs were based on public US data from the CDC and national databases, while data on vaccine effectiveness were extracted from published literature and clinical trials. The impact of HD TIV was further explored in five scenario analyses and deterministic sensitivity analyses (DSA).

RESULTS

Over 10 years, it is estimated that HD TIV resulted in an averted 1,333,479 influenza cases, 769,476 medical visits, 40,004 ED presentations, 520,342 cardiorespiratory hospitalizations and 73,689 deaths and generated an absolute $4.6 billion in savings, translating into a return on investment of 214.4%. Hospitalizations costs represented 98.4% and 98.3% of the management costs in the 'with HD TIV' strategy and 'without HD TIV' strategy respectively. Hospitalizations and HD TIV relative vaccine efficacy vs SD TIV as a major cost driver were further confirmed in scenario analysis and DSA. HD TIV remained cost saving under all the scenarios.

CONCLUSION

The model showed that HD TIV higher efficacy translated into increased averted health and economic outcomes. HD TIV represented a cost saving intervention from a payer perspective since its introduction.

Efficacy and effectiveness of high-dose influenza vaccine in older adults by circulating strain and antigenic match: An updated systematic review and meta-analysis

BACKGROUND

Influenza vaccine efficacy/effectiveness can vary from season to season due in part to the dominant circulating strains and antigenic matching. This study reviews the relative vaccine efficacy/effectiveness (rVE) of high-dose inactivated trivalent influenza vaccine (HD-IIV3) compared to standard-dose influenza vaccines (SD-IIV) in adults aged ≥ 65 years against influenza-associated outcomes. Additional sub-analyses of HD-IIV3 rVE were performed by the predominantly circulating influenza strain and the antigenic match or mismatch of the vaccine against the predominant circulating strains.

METHODS

An updated systematic review and meta-analysis was conducted for studies assessing the rVE of HD-IIV3 against probable/laboratory-confirmed influenza-like illness (ILI), hospital admissions, and death in adults aged ≥ 65 years. Results from individual seasons were extracted from the studies, and viral surveillance data were used to determine the dominant circulating strains and antigenic match for each season. Results were then stratified based on clinical outcomes and seasonal characteristics and meta-analyzed to estimate pooled rVEs of HD-IIV3.

RESULTS

15 publications were meta-analyzed after screening 1,293 studies, providing data on 10 consecutive influenza seasons and over 22 million individuals receiving HD-IIV3 in randomized and observational settings. Across all influenza seasons, HD-IIV3 demonstrated improved protection against ILI compared to SD-IIV (rVE = 15.9%, 95% CI: 4.1-26.3%). HD-IIV3 was also more effective at preventing hospital admissions from all-causes (rVE = 8.4%, 95% CI: 5.7-11.0%), as well as influenza (rVE = 11.7%, 95% CI: 7.0-16.1%), pneumonia (rVE = 27.3%, 95% CI: 15.3-37.6%), combined pneumonia/influenza (rVE = 13.4%, 95% CI: 7.3-19.2%) and cardiorespiratory events (rVE = 17.9%, 95% CI: 15.0-20.8%). Reductions in mortality due to pneumonia/influenza (rVE = 39.9%, 95% CI: 18.6-55.6%) and cardiorespiratory causes (rVE = 27.7%, 95% CI: 13.2-32.0%) were also observed. Similar pooled rVEs were observed in both matched and mismatched seasons and in seasons where A/H3N2 or A/H1N1 strains were predominantly circulating.

CONCLUSIONS

Evidence over 10 consecutive influenza seasons and in more than 34 million individuals aged ≥ 65 years suggests that HD-IIV3 is consistently more effective than SD-IIV at reducing influenza cases as well as influenza-associated clinical complications irrespective of circulating strain and antigenic match. A video summary of the article can be accessed via the Supplementary data link at the end of this article.

High-Dose Inactivated Influenza Vaccine Quadrivalent for Older Adults

OBJECTIVE

To review the efficacy and safety of the high-dose inactivated influenza vaccine quadrivalent (HD-IIV4) in the prevention of influenza in older adults.

DATA SOURCES

A literature search was performed using PubMed and Google Scholar with the search terms high-dose, influenza vaccine, and quadrivalent. Other resources included the Centers for Disease Control and Prevention (CDC), the prescribing information, and the manufacturer's website.

STUDY SELECTION AND DATA EXTRACTION

All relevant English-language articles of studies assessing the efficacy and safety of HD-IIV4 were included.

DATA SYNTHESIS

HD-IIV4 is licensed by the Food and Drug Administration for the prevention of influenza in adults aged 65 years and older. The safety and immunogenicity of HD-IIV4 was demonstrated in a phase 3 trial, and the efficacy of the trivalent formulation (HD-IIV3) was demonstrated in a phase 3b-4 trial. HD-IIV4 carries a warning regarding the occurrence of Guillain-Barré syndrome. Adverse reactions, including injection-site pain and myalgia, were reported more frequently with HD-IIV4 than with HD-IIV3.

RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE

Although the CDC recommends any age-appropriate influenza vaccine for adults aged 65 years and older, HD-IIV4 was associated with improved immunogenicity against the added B strain and HD-IIV3 provided better protection against influenza than the standard-dose vaccine. Other influenza vaccines have weaker evidence of efficacy in older adults. Therefore, HDIIV4 should be recommended as the vaccine of choice in adults aged 65 years and older.

CONCLUSION

HD-IIV4 has proven immunogenic, safe, and effective in preventing influenza in older adults and should be recommended as the vaccine of choice in this patient population.

Comparing the impact of high-dose versus standard dose influenza vaccines on hospitalization cost for cardiovascular and respiratory diseases: Economic assessment in the US Veteran population during 5 respiratory seasons using an instrumental variable method

OBJECTIVES

Cost savings associated with high-dose (HD) as compared to standard-dose (SD) influenza vaccination in the United States (US) Veteran's Health Administration (VHA) population have been attributed to better protection against hospitalization for cardiac and respiratory diseases. The relative contribution of each of these disease categories to the reported savings remains to be explored.

METHODS

During a recently completed study of HD versus SD vaccine effectiveness (conducted in the VHA over five respiratory seasons from 2010/11 through 2014/15), we collected cost data for all healthcare services provided at both VHA and Medicare-funded facilities. In that analysis, we compared the costs of vaccination and hospital care for patients admitted with either cardiovascular or respiratory disease. Treatment selection bias and other confounding factors were adjusted using an instrumental variable (IV) method. In this brief report we use the same study cohort and methods to stratify the results by patients admitted for cardiovascular disease (CVD) and those admitted for respiratory disease.

RESULTS

We analyzed 3.5 million SD and 0.16 million HD person-seasons. The IV-adjusted rVEs were 14% (7-20%) against hospitalizations for CVD and 15% (5-25%) against respiratory hospitalizations. Net cost savings per HD recipient were $138 ($66-$200) for CVD related hospitalizations and $62 ($10-$107) for respiratory disease related hospitalizations.

CONCLUSIONS

In the US VHA population, the reduction in hospitalizations for CVD over five respiratory seasons contributed twice the cost savings (per HD recipient) of the reduction in hospitalizations for respiratory disease.