title: Cost-effectiveness analysis of quadrivalent influenza vaccine in Spain.
abstract: Influenza has a major impact on healthcare systems and society, but can be prevented using vaccination. The World Health Organization (WHO) currently recommends that influenza vaccines should include at least two virus A and one virus B lineage (trivalent vaccine; TIV). A new quadrivalent vaccine (QIV), which includes an additional B virus strain, received regulatory approval and is now recommended by several countries. The present study estimates the cost-effectiveness of replacing TIVs with QIV for risk groups and elderly population in Spain. A static, lifetime, multi-cohort Markov model with a one-year cycle time was adapted to assess the costs and health outcomes associated with a switch from TIV to QIV. The model followed a cohort vaccinated each year according to health authority recommendations, for the duration of their lives. National epidemiological data allowed the determination of whether the B strain included in TIVs matched the circulating one. Societal perspective was considered, costs and outcomes were discounted at 3% and one-way and probabilistic sensitivity analyses were performed. Compared to TIVs, QIV reduced more influenza cases and influenza-related complications and deaths during periods of B-mismatch strains in the TIV. The incremental cost-effectiveness ratio (ICER) was 8,748€/quality-adjusted life year (QALY). One-way sensitivity analysis showed mismatch with the B lineage included in the TIV was the main driver for ICER. Probabilistic sensitivity analysis shows ICER below 30,000€/QALY in 96% of simulations. Replacing TIVs with QIV in Spain could improve influenza prevention by avoiding B virus mismatch and provide a cost-effective healthcare intervention.
authors.affiliation: a Servicio Epidemiología y Prevención , DG Salud Pública Servicio Canario de Salud , Las Palmas , Spain.
authors.forename: Amos
authors.initials: A
authors.lastname: García
authors.affiliation: b National Influenza Center , Servicio Microbiología Hospital Clínico Valladolid , Valladolid , Spain.
authors.forename: Raúl
authors.initials: R
authors.lastname: Ortiz de Lejarazu
authors.affiliation: c Centro de Referencia de la Gripe , Servicio Microbiología Hospital Universitario Son Espases , Palma de Mallorca , Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Reina
authors.affiliation: d BAP Health Outcomes Research , Oviedo , Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Callejo
authors.affiliation: d BAP Health Outcomes Research , Oviedo , Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Cuervo
authors.affiliation: e Dpto. Evaluación de Medicamentos , GSK , Madrid , Spain.
authors.forename: Raúl
authors.initials: R
authors.lastname: Morano Larragueta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007223:Infant; D007252:Influenza Vaccines / Q000008:administration & dosage / Q000191:economics* / Q000276:immunology*; D007251:Influenza, Human / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines
keywords: QIV; cost-effectiveness analysis; costs and cost analysis; healthcare costs; human; influenza; influenza B virus; influenza vaccines; vaccines