21396760

PMC3085888

Background

Currently, over 340,000 individuals are receiving long-term hemodialysis (HD) therapy for end-stage renal disease and therefore are particularly vulnerable to influenza, prone to more severe influenza outcomes, and less likely to achieve seroprotection from standard influenza vaccines. Influenza vaccine adjuvants, chemical or biological compounds added to a vaccine to boost the elicited immunological response, may help overcome this problem.

Study design

Economic stochastic decision analytic simulation model.

Setting & Participants

United States adult HD population.

Model, Perspective, & Timeframe

The model simulated the decision to use either an adjuvanted or non-adjuvanted vaccine, assumed the societal perspective, and represented a single influenza season, or 1 year.

Intervention

Adjuvanted influenza vaccine at different adjuvant costs and efficacies. Sensitivity analyses explored the impact of varying the influenza clinical attack rate, influenza hospitalization rate, and influenza-related mortality.

Outcomes

Incremental cost-effectiveness ratio (ICER) of adjuvanted influenza vaccine (versus non-adjuvanted) with effectiveness measured in quality-adjusted life-years (QALYs).

Results

Adjuvanted influenza vaccine would be cost-effective (ICER<$50,000/QALY) at a $1 adjuvant cost (on top of the standard vaccine cost) when the adjuvant efficacy (in overcoming the difference between influenza vaccine response in HD patients and healthy adults) ≥60% and economically dominant (provides both cost savings and health benefits) when the $1 adjuvant's efficacy is 100%. A $2 adjuvant would be cost-effective should the adjuvant efficacy be 100%.

Limitations

All models are simplifications of real life and cannot possibly capture all possible factors and outcomes.

Conclusions

An adjuvanted influenza vaccine with adjuvant cost ≤$2 could be cost-effective strategy in a standard influenza season depending on the potency of the adjuvant.

CDC Public Access

5P01HK000086-02/HK/PHITPO CDC HHS/United States
5R01LM009132-03/LM/NLM NIH HHS/United States
5U54GM088491-02/GM/NIGMS NIH HHS/United States
R01 LM009132/LM/NLM NIH HHS/United States
R01 LM009132-04/LM/NLM NIH HHS/United States
U54 GM088491/GM/NIGMS NIH HHS/United States
U54 GM088491-02/GM/NIGMS NIH HHS/United States