title: Cost-Utility of Quadrivalent Versus Trivalent Influenza Vaccine in Germany, Using an Individual-Based Dynamic Transmission Model.
abstract: Seasonal influenza infection is primarily caused by circulation of two influenza A strain subtypes and strains from two B lineages that vary each year. Trivalent influenza vaccine (TIV) contains only one of the two B-lineage strains, resulting in mismatches between vaccine strains and the predominant circulating B lineage. Quadrivalent influenza vaccine (QIV) includes both B-lineage strains. The objective was to estimate the cost-utility of introducing QIV to replace TIV in Germany.
  
  
  
  An individual-based dynamic transmission model (4Flu) using German data was used to provide realistic estimates of the impact of TIV and QIV on age-specific influenza infections. Cases were linked to health and economic outcomes to calculate the cost-utility of QIV versus TIV, from both a societal and payer perspective. Costs and effects were discounted at 3.0 and 1.5 % respectively, with 2014 as the base year. Univariate and probabilistic sensitivity analyses were conducted.
  
  
  
  Using QIV instead of TIV resulted in additional quality-adjusted life-years (QALYs) and cost savings from the societal perspective (i.e. it represents the dominant strategy) and an incremental cost-utility ratio (ICUR) of €14,461 per QALY from a healthcare payer perspective. In all univariate analyses, QIV remained cost-effective (ICUR <€50,000). In probabilistic sensitivity analyses, QIV was cost-effective in >98 and >99 % of the simulations from the societal and payer perspective, respectively.
  
  
  
  This analysis suggests that QIV in Germany would provide additional health gains while being cost-saving to society or costing €14,461 per QALY gained from the healthcare payer perspective, compared with TIV.
authors.affiliation: PharmacoEpidemiology and PharmacoEconomics, University of Groningen, Antonius Deusinglaan 1, 9713 GZ, Groningen, The Netherlands. christiaandolk@gmail.com.
authors.forename: Christiaan
authors.identifier: 0000-0001-7191-115X
authors.initials: C
authors.lastname: Dolk
authors.affiliation: Epimos GmbH, Uhlandstrasse 3, 72144, Dusslingen, Germany.|Clinical Epidemiology and Applied Biometry, Tübingen University, Silcherstrasse 5, 72076, Tübingen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Eichner
authors.affiliation: GSK Germany, Prinzregentenplatz 9, 81675, München, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Welte
authors.affiliation: GSK Germany, Prinzregentenplatz 9, 81675, München, Germany.
authors.forename: Anastassia
authors.initials: A
authors.lastname: Anastassopoulou
authors.affiliation: CHESS, Zwarte Leeuwstraat 69, 2820, Bonheiden, Belgium.
authors.forename: Laure-Anne
authors.initials: LA
authors.lastname: Van Bellinghen
authors.affiliation: EAH-Consulting, Karlsgraben 12, 52064, Aachen, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Poulsen Nautrup
authors.affiliation: CHESS, Zwarte Leeuwstraat 69, 2820, Bonheiden, Belgium.
authors.forename: Ilse
authors.initials: I
authors.lastname: Van Vlaenderen
authors.affiliation: GSK Germany, Prinzregentenplatz 9, 81675, München, Germany.|GSK Vaccines, Avenue Fleming 20, 1300, Wavre, Belgium.
authors.forename: Ruprecht
authors.initials: R
authors.lastname: Schmidt-Ott
authors.affiliation: ExploSYS GmbH, Otto-Hahn-Weg 6, 70771, Leinfelden-Echterdingen, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Schwehm
authors.affiliation: PharmacoEpidemiology and PharmacoEconomics, University of Groningen, Antonius Deusinglaan 1, 9713 GZ, Groningen, The Netherlands.|Institute for Science in Healthy Aging and healthcaRE (SHARE), University Medical Center Groningen (UMCG), Hanzeplein 1, Groningen, 9713 GZ, The Netherlands.|Department of Epidemiology, University Medical Center Groningen (UMCG), Hanzeplein 1, Groningen, 9713 GZ, The Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: Postma
mesh_terms: D000367:Age Factors; D003362:Cost-Benefit Analysis; D005858:Germany; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage* / Q000191:economics; D007251:Influenza, Human / Q000191:economics / Q000517:prevention & control / Q000821:virology; D015233:Models, Statistical; D019057:Quality-Adjusted Life Years
chemical_list: D007252:Influenza Vaccines