tetano
Editor, Senior Moderator
Braz J Infect Dis. 2018 Jan 17. pii: S1413-8670(17)30654-2. doi: 10.1016/j.bjid.2017.11.004. [Epub ahead of print]
[h=1]Cost-utility of quadrivalent versus trivalent influenza vaccine in Brazil - comparison of outcomes from different static model types.[/h] Bellinghen LV[SUP]1[/SUP], Marijam A[SUP]2[/SUP], Araujo GT[SUP]3[/SUP], Gomez J[SUP]4[/SUP], Vlaenderen IV[SUP]5[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] Influenza burden in Brazil is considerable with 4.2-6.4 million cases in 2008 and influenza-like-illness responsible for 16.9% of hospitalizations. Cost-effectiveness of influenza vaccination may be assessed by different types of models, with limitations due to data availability, assumptions, and modelling approach.
[h=4]OBJECTIVE:[/h] To understand the impact of model complexity, the cost-utility of quadrivalent versus trivalent influenza vaccines (QIV versus TIV) in Brazil was estimated using three distinct models: a 1-year decision tree population model with three age groups (FLOU); a more detailed 1-year population model with five age groups (FLORA); and a more complex lifetime multi-cohort Markov model with nine age groups (FLORENCE).
[h=4]METHODS:[/h] Analysis 1 (impact of model structure) compared each model using the same data inputs (i.e., best available data for FLOU). Analysis 2 (impact of increasing granularity) compared each model populated with the best available data for that model.
[h=4]RESULTS:[/h] Using the best data for each model, the discounted cost-utility ratio of QIV versus TIV was R$20,428 with FLOU, R$22,768 with FLORA (versus R$20,428 in Analysis 1), and, R$19,257 with FLORENCE (versus R$22,490 in Analysis 1) using a lifetime horizon. Conceptual differences between FLORA and FLORENCE meant the same assumption regarding increased all-cause mortality in at-risk individuals had an opposite effect on the incremental cost-effectiveness ratio (ICER) in Analysis 2 versus 1, and a proportionally higher number of vaccinated elderly in FLORENCE reduced the ICER in Analysis 2.
[h=4]DISCUSSION:[/h] FLOU provided adequate cost-effectiveness estimates with data in broad age groups. FLORA increased insights (e.g., in healthy versus at-risk, paediatric, respiratory/non-respiratory complications). FLORENCE provided greater insights and precision (e.g., in elderly, costs and complications, lifetime cost-effectiveness).
[h=4]CONCLUSION:[/h] All three models predicted a cost per QALY gained for QIV versus TIV in the range of R$19,257 (FLORENCE) to R$22,768 (FLORA) with the best available data in Brazil.
Copyright ? 2018. Published by Elsevier Editora Ltda.
[h=4]KEYWORDS:[/h] Brazil; Cost-effectiveness; Influenza; QIV; TIV; Vaccination
PMID: 29352897 DOI: 10.1016/j.bjid.2017.11.004
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[h=1]Cost-utility of quadrivalent versus trivalent influenza vaccine in Brazil - comparison of outcomes from different static model types.[/h] Bellinghen LV[SUP]1[/SUP], Marijam A[SUP]2[/SUP], Araujo GT[SUP]3[/SUP], Gomez J[SUP]4[/SUP], Vlaenderen IV[SUP]5[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] Influenza burden in Brazil is considerable with 4.2-6.4 million cases in 2008 and influenza-like-illness responsible for 16.9% of hospitalizations. Cost-effectiveness of influenza vaccination may be assessed by different types of models, with limitations due to data availability, assumptions, and modelling approach.
[h=4]OBJECTIVE:[/h] To understand the impact of model complexity, the cost-utility of quadrivalent versus trivalent influenza vaccines (QIV versus TIV) in Brazil was estimated using three distinct models: a 1-year decision tree population model with three age groups (FLOU); a more detailed 1-year population model with five age groups (FLORA); and a more complex lifetime multi-cohort Markov model with nine age groups (FLORENCE).
[h=4]METHODS:[/h] Analysis 1 (impact of model structure) compared each model using the same data inputs (i.e., best available data for FLOU). Analysis 2 (impact of increasing granularity) compared each model populated with the best available data for that model.
[h=4]RESULTS:[/h] Using the best data for each model, the discounted cost-utility ratio of QIV versus TIV was R$20,428 with FLOU, R$22,768 with FLORA (versus R$20,428 in Analysis 1), and, R$19,257 with FLORENCE (versus R$22,490 in Analysis 1) using a lifetime horizon. Conceptual differences between FLORA and FLORENCE meant the same assumption regarding increased all-cause mortality in at-risk individuals had an opposite effect on the incremental cost-effectiveness ratio (ICER) in Analysis 2 versus 1, and a proportionally higher number of vaccinated elderly in FLORENCE reduced the ICER in Analysis 2.
[h=4]DISCUSSION:[/h] FLOU provided adequate cost-effectiveness estimates with data in broad age groups. FLORA increased insights (e.g., in healthy versus at-risk, paediatric, respiratory/non-respiratory complications). FLORENCE provided greater insights and precision (e.g., in elderly, costs and complications, lifetime cost-effectiveness).
[h=4]CONCLUSION:[/h] All three models predicted a cost per QALY gained for QIV versus TIV in the range of R$19,257 (FLORENCE) to R$22,768 (FLORA) with the best available data in Brazil.
Copyright ? 2018. Published by Elsevier Editora Ltda.
[h=4]KEYWORDS:[/h] Brazil; Cost-effectiveness; Influenza; QIV; TIV; Vaccination
PMID: 29352897 DOI: 10.1016/j.bjid.2017.11.004
Free full text