Cost-Effectiveness of Adjuvanted Versus Nonadjuvanted Influenza Vaccine in Adult Hemodialysis Patients

Details

• Alternative Title:
  Am J Kidney Dis
• Personal Author:
  Lee, Bruce Y. ; Stalter, Randy M. ; Bacon, Kristina M. ; Tai, Julie H.Y. ; Bailey, Rachel R. ; Zimmer, Shanta M. ; Wagner, Michael M.
• Description:
  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.
  
  
• Subjects:
  Adjuvants, Immunologic Adult Aged Cost-Benefit Analysis Decision Trees Female Humans Influenza, Human Influenza Vaccines Kidney Failure, Chronic Male Middle Aged Renal Dialysis

  More +
• Keywords:
  Computer Model Computer Simulation Cost-effectiveness End-Stage Renal Disease Hemodialysis Immunodeficiency Influenza Vaccine Seasonal Influenza Vaccine Adjuvant
• Source:
  Am J Kidney Dis. 2011; 57(5):724-732
• Pubmed ID:
  21396760
• Pubmed Central ID:
  PMC3085888
• Document Type:
  Journal Article
• Funding:
  5R01LM009132-03/LM/NLM NIH HHSUnited States/ ; 5U54GM088491-02/GM/NIGMS NIH HHSUnited States/ ; P01 HK000086/HK/PHITPO CDC HHSUnited States/ ; U54 GM088491/GM/NIGMS NIH HHSUnited States/ ; R01 LM009132/LM/NLM NIH HHSUnited States/ ; 5P01HK000086-02/HK/PHITPO CDC HHSUnited States/ ; R01 LM009132-04/LM/NLM NIH HHSUnited States/ ; U54 GM088491-02/GM/NIGMS NIH HHSUnited States/
• Volume:
  57
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:b82ebd5e8d921738c73a74a383d63ecbed3342a58339cb13ee0e81cdb2f7503b
• Download URL:
  https://stacks.cdc.gov/view/cdc/33198/cdc_33198_DS1.pdf
• File Type:
  [PDF - 445.07 KB ]