Cost-Effectiveness of Increasing Influenza Vaccination Coverage in Adults with Type 2 Diabetes in Turkey.
OBJECTIVE
In Turkey, the prevalence of diabetes is high but the influenza vaccination coverage rate (VCR) is low (9.1% in 2014), despite vaccination being recommended and reimbursed. This study evaluated the cost-effectiveness of increasing the influenza VCR of adults with type 2 diabetes in Turkey to 20%.


METHODS
A decision-analytic model was adapted to Turkey using data derived from published sources. Direct medical costs and indirect costs due to productivity loss were included in the societal perspective. The time horizon was set at 1 year to reflect the seasonality of influenza.


RESULTS
Increasing the VCR for adults with type 2 diabetes to 20% is predicted to avert an additional 19,777 influenza cases, 2376 hospitalizations, and 236 deaths. Associated influenza costs avoided were estimated at more than 8.3 million Turkish Lira (TRY), while the cost of vaccination would be more than TRY 8.4 million. The incremental cost-effectiveness ratio was estimated at TRY 64/quality-adjusted life years, which is below the per capita gross domestic product of TRY 21,511 and therefore very cost-effective according to World Health Organization guidelines. Factors most influencing the incremental cost-effectiveness ratio were the excess hospitalization rate, inpatient cost, vaccine effectiveness against hospitalization, and influenza attack rate. Increasing the VCR to >20% was also estimated to be very cost-effective.


CONCLUSIONS
Increasing the VCR for adults with type 2 diabetes in Turkey to ≥20% would be very cost-effective.
Hacettepe University Faculty of Medicine, Department of Public Health, Üniversiteler Mh., 06640 Ankara, Turkey.
Levent
L
Akın
Sanofi Pasteur, 2 Avenue Pont Pasteur, Lyon 69007, France.
Bérengère
B
Macabéo
Hacettepe University, Department of Economics, 06800, Beytepe, Ankara, Turkey.
Zafer
Z
Caliskan
Sanofi Pasteur, Büyükdere Cad. No:193 K:3 Levent-34394, Istanbul, Turkey.
Serdar
S
Altinel
Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Turgut Ozal Millet Cad, P.K. 33, Capa 34093, Istanbul, Turkey.
Ilhan
I
Satman
D000328:Adult; D003362:Cost-Benefit Analysis / Q000191:economics*; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000276:immunology*; D006801:Humans; D007251:Influenza, Human / Q000191:economics*; D008962:Models, Theoretical; D011336:Probability; D014421:Turkey; D014611:Vaccination / Q000191:economics*