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High-dose flu vaccine less costly, more effective than standard dose in seniors
Compared with standard-dose inactivated influenza vaccine, the high-dose formulation lowers costs and is more effective in adults aged 65 years and older, according to a study conducted in Canada.
“We have previously demonstrated [high-dose inactivated influenza vaccine (IIV-HD)] to be a less costly and more effective alternative to [standard-dose (IIV-SD)] in a United States-focused cost-utility analysis conducted from both a Medicare and societal perspective,” Ayman Chit, PhD, an investigator for Sanofi Pasteur, and colleagues wrote in Human Vaccines and Immunotherapeutics. “The objective of the current analysis was to determine if vaccination with the newly approved IIV-HD versus SD would lead to similar economic benefits in Canada when Canadian unit costs and survival data were considered in place of those used in our U.S. analysis.”
The researchers performed a cost-utility analysis based on detailed data on health care use and clinical outcomes collected from a randomized controlled clinical trial, dubbed FIM12. The trial compared IIV-HD with IIV-SD in approximately 32,000 seniors in the U.S. and Canada over the 2011-2012 and 2012-2013 influenza seasons, and found that IIV-HD was 24.2% (95% CI 9.7–36.5) more effective than IIV-SD.
For the present study, Chit and colleagues compared the cost and efficacy of IIV-HD vs. IIV-SD based on medication use, nonroutine/urgent care and ER visits, and hospitalizations, and focused their analysis on Canadian seniors.
In their analysis of health care use, Hecker and colleagues found slightly more per-patient visits to the ER (outcomes per vaccine, 0.0131 vs. 0.0128; difference = 0.0003) and nonroutine/urgent care visits (0.2257 vs. 0.2179; difference = 0.0078) in the IIV-HD group than in the SD group, and slightly lower prescription (0.1977 vs. 0.1985; difference = –0.0008) and nonprescription (0.1811 vs. 0.1839; difference = –0.0028) medication use. Hospitalizations, which contributed 91% of the total cost, were less frequent in those who received IIV-HD. The mean per-participant number of hospitalizations was 0.0937 (1,498 hospitalizations in 15,990 participants) in the IIV-HD group and 0.1017 (1,629 hospitalizations in 15,993 participants) in the IIV-SD group. Hospital length of stay per patient averaged 0.4869 days in the IIV-HD group and 0.5626 days in the IIV-SD group.
Chit and colleagues also discovered IIV-HD to be a cost-saving alternative to IIV-SD. Average medical costs per person were approximately 47 Canadian dollars less for those who received IIV-HD. Societal costs show approximate savings of 60 Canadian dollars per IIV-HD participant when nonprescription drug and productivity costs were added to public payer medical costs, according to the researchers.
Moreover, IIV-HD provided a gain in quality-adjusted life-years (QALYs) compared with IIV-SD (8.1502 vs. 8.1499 QALYs per participant).
“These findings are relevant to Canadian health care beneficiaries, providers, payers and recommending bodies, especially those looking to improve outcomes while containing costs,” Chit said in a press release. – by Savannah Demko
References:
Becker DL, et al. Human Vaccines & Immunotherapeutics. 2016;doi:10.1080/21645515.2016.1215395.
Chit A, et al. Lancet Infect Dis. 2015;doi:10.1016/S1473-3099(15)00249-2.
Disclosure: Sanofi Pasteur funded the study. Please see the full study for a list of all researchers’ relevant financial disclosures.
Perspective
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From a clinical perspective, these findings reinforce the value of high-dose influenza vaccine. There are now two products available for people aged 65 years and older, both of which have data indicating that they performed very well — in fact, in a superior fashion — in this age group. The CDC’s Advisory Committee on Immunization Practices has not expressed a preference between high-dose and standard-dose influenza vaccine, but many are now aware of these data and are switching to using high-dose or adjuvanted vaccines for this age group.