title: Estimation of the health impact and cost-effectiveness of influenza vaccination with enhanced effectiveness in Canada.
abstract: BACKGROUND
  The propensity for influenza viruses to mutate and recombine makes them both a familiar threat and a prototype emerging infectious disease. Emerging evidence suggests that the use of MF59-adjuvanted vaccines in older adults and young children enhances protection against influenza infection and reduces adverse influenza-attributable outcomes compared to unadjuvanted vaccines. The health and economic impact of such vaccines in the Canadian population are uncertain.
  
  
  METHODS
  We constructed an age-structured compartmental model simulating the transmission of influenza in the Canadian population over a ten-year period. We compared projected health outcomes (quality-adjusted life years (QALY) lost), costs, and incremental cost-effectiveness ratios (ICERs) for three strategies: (i) current use of unadjuvanted trivalent influenza vaccine; (ii) use of MF59-adjuvanted influenza vaccine adults ≥65 in the Canadian population, and (iii) adjuvanted vaccine used in both older adults and children aged < 6.
  
  
  RESULTS
  In the base case analysis, use of adjuvanted vaccine in older adults was highly cost-effective (ICER = $2111/QALY gained), but such a program was "dominated" by a program that extended the use of adjuvanted vaccine to include young children (ICER = $1612/QALY). Results were similar whether or not a universal influenza immunization program was used in other age groups; projections were robust in the face of wide-ranging sensitivity analyses.
  
  
  CONCLUSIONS
  Based on the best available data, it is projected that replacement of traditional trivalent influenza vaccines with MF59-adjuvanted vaccines would confer substantial benefits to vaccinated and unvaccinated individuals, and would be economically attractive relative to other widely-used preventive interventions.
authors: Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. david.fisman@utoronto.ca
authors: David N
authors: DN
authors: Fisman
authors: Ashleigh R
authors: AR
authors: Tuite
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002138:Calibration; D002170:Canada; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D006262:Health; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007252:Influenza Vaccines / Q000191:economics* / Q000276:immunology*; D007251:Influenza, Human / Q000517:prevention & control / Q000635:transmission; D008875:Middle Aged; D008954:Models, Biological; D011788:Quality of Life; D013997:Time Factors; D014611:Vaccination / Q000191:economics* / Q000379:methods* / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines