title: Cost-Effectiveness and Public Health Effect of Influenza Vaccine Strategies for U.S. Elderly Adults.
abstract: To compare the cost-effectiveness of four influenza vaccines available in the United States for persons aged 65 and older: trivalent inactivated influenza vaccine (IIV3), quadrivalent inactivated influenza vaccine (IIV4), a more-expensive high-dose IIV3, and a newly approved adjuvanted IIV3.
  
  
  
  Cost-effectiveness analysis using a Markov model and sensitivity analyses.
  
  
  
  A hypothetical influenza vaccination season modeled according to possible U.S. influenza vaccination policies.
  
  
  
  Hypothetical cohort of individuals aged 65 and older in the United States.
  
  
  
  Cost-effectiveness and public health benefits of available influenza vaccination strategies in U.S. elderly adults.
  
  
  
  IIV3 cost $3,690 per quality-adjusted life year (QALY) gained, IIV4 cost $20,939 more than IIV3 per QALY gained, and high-dose IIV3 cost $31,214 more per QALY than IIV4. The model projected 83,775 fewer influenza cases and 980 fewer deaths with high-dose IIV3 than with the next most-effective vaccine: IIV4. In a probabilistic sensitivity analysis, high-dose IIV3 was the favored strategy if willingness to pay is $25,000 or more per QALY gained. Adjuvanted IIV3 cost-effectiveness depends on its price and effectiveness (neither yet determined in the United States) but could be favored if its relative effectiveness is 15% greater than that of IIV3.
  
  
  
  From economic and public health standpoints, high-dose IIV3 for adults aged 65 years and older is likely to be favored over the other vaccines, based on currently available data. The cost-effectiveness of adjuvanted IIV3 should be reviewed after its effectiveness has been compared with that of other vaccines and its U.S. price is established.
authors.affiliation: School of Medicine, University of Pittsburgh, Pennsylvania. raviottaj@upmc.edu.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Raviotta
authors.affiliation: School of Medicine, University of Pittsburgh, Pennsylvania.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Smith
authors.affiliation: Pittsburgh Supercomputing Center, Carnegie Mellon University, Pittsburgh, Pennsylvania.
authors.forename: Jay
authors.initials: J
authors.lastname: DePasse
authors.affiliation: Pittsburgh Supercomputing Center, Carnegie Mellon University, Pittsburgh, Pennsylvania.
authors.forename: Shawn T
authors.initials: ST
authors.lastname: Brown
authors.affiliation: Department of Mathematics, Soongsil University, Seoul, South Korea.
authors.forename: Eunha
authors.initials: E
authors.lastname: Shim
authors.affiliation: School of Medicine, University of Pittsburgh, Pennsylvania.
authors.forename: Mary Patricia
authors.initials: MP
authors.lastname: Nowalk
authors.affiliation: School of Medicine, University of Pittsburgh, Pennsylvania.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Zimmerman
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007252:Influenza Vaccines / Q000145:classification / Q000627:therapeutic use; D007251:Influenza, Human / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D008390:Markov Chains; D008962:Models, Theoretical; D011634:Public Health / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014611:Vaccination / Q000191:economics / Q000379:methods
chemical_list: D007252:Influenza Vaccines
keywords: cost effectiveness; high-dose IIV3; influenza vaccination