Cost-Effectiveness of High-Dose Trivalent Influenza Vaccine in the Elderly: A Cohort-Based Economic Model From the Italian NHS Perspective
Author(s)
Marco Bellone, MSc1, Alberto Piccolo, PharmD2, Donatella Panatto, PhD3, Laura Zanetta, MD2, Luca Castello, MBA1.
1AdRes HE&OR, Turin, Italy, 2Sanofi, Milan, Italy, 3University of Genoa, Genoa, Italy.
1AdRes HE&OR, Turin, Italy, 2Sanofi, Milan, Italy, 3University of Genoa, Genoa, Italy.
OBJECTIVES: Seasonal influenza causes significant morbidity, hospitalizations, and mortality, particularly among elderly individuals. High-dose trivalent influenza vaccine (TIV-HD) offers superior protection over the standard-dose vaccine (TIV-SD). This study assessed the cost-effectiveness of TIV-HD versus TIV-SD in the Italian elderly population (≥65 years).
METHODS: A cohort-based decision tree analytic model simulated clinical and economic outcomes from the National Health Service (NHS) perspective. It captured symptomatic influenza cases, hospitalizations for cardiorespiratory complications, and influenza-attributable mortality. Multiple pricing scenarios were explored, reflecting theoretical procurement conditions. Outcomes included healthcare costs, clinical events, and projected life-years (LYs) and quality-adjusted life years (QALYs). The time horizon of the analysis was one year for clinical events and healthcare resource use; however, lifetime projections were applied to estimate the impact of premature mortality on survival and quality-adjusted life expectancy. Vaccination coverage was applied based on national surveillance data, while costs were derived from official Italian healthcare and tariff sources.
RESULTS: TIV-HD was a dominant strategy over TIV-SD across all modelled scenarios. Its use resulted in a substantial reduction of the clinical burden, preventing approximately 71,000 influenza cases, 50,000 hospitalizations for cardiorespiratory complications, and 1,400 influenza-related deaths in the Italian elderly population. The clinical benefits associated with TIV-HD resulted in 13,700 QALYs gained across the modelled cohort. The intervention also produced substantial economic benefits, with net savings ranging from €82 million to €135 million, depending on the premium price over TIV-SD. Deterministic and probabilistic sensitivity analyses confirmed the robustness of results across all tested assumptions.
CONCLUSIONS: TIV-HD provides substantial clinical and economic advantages over TIV-SD in the elderly (≥65 years). Its dominance persists across a wide range of price assumptions, reinforcing its value and supporting its preferential inclusion in national immunization strategies. The intervention remains well within - and likely beyond - established value-based pricing thresholds, confirming its strong cost-effectiveness profile.
METHODS: A cohort-based decision tree analytic model simulated clinical and economic outcomes from the National Health Service (NHS) perspective. It captured symptomatic influenza cases, hospitalizations for cardiorespiratory complications, and influenza-attributable mortality. Multiple pricing scenarios were explored, reflecting theoretical procurement conditions. Outcomes included healthcare costs, clinical events, and projected life-years (LYs) and quality-adjusted life years (QALYs). The time horizon of the analysis was one year for clinical events and healthcare resource use; however, lifetime projections were applied to estimate the impact of premature mortality on survival and quality-adjusted life expectancy. Vaccination coverage was applied based on national surveillance data, while costs were derived from official Italian healthcare and tariff sources.
RESULTS: TIV-HD was a dominant strategy over TIV-SD across all modelled scenarios. Its use resulted in a substantial reduction of the clinical burden, preventing approximately 71,000 influenza cases, 50,000 hospitalizations for cardiorespiratory complications, and 1,400 influenza-related deaths in the Italian elderly population. The clinical benefits associated with TIV-HD resulted in 13,700 QALYs gained across the modelled cohort. The intervention also produced substantial economic benefits, with net savings ranging from €82 million to €135 million, depending on the premium price over TIV-SD. Deterministic and probabilistic sensitivity analyses confirmed the robustness of results across all tested assumptions.
CONCLUSIONS: TIV-HD provides substantial clinical and economic advantages over TIV-SD in the elderly (≥65 years). Its dominance persists across a wide range of price assumptions, reinforcing its value and supporting its preferential inclusion in national immunization strategies. The intervention remains well within - and likely beyond - established value-based pricing thresholds, confirming its strong cost-effectiveness profile.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE253
Topic
Clinical Outcomes, Economic Evaluation, Epidemiology & Public Health
Disease
Vaccines