Cost-Utility Analysis of Standard-Dose vs. High-Dose Influenza Vaccination in Adults Aged ?65 Years in Italy
Author(s)
Giuseppe Pompilio, MSc1, Claudio Bellomo, PharmaD1, Andrea Pannunzio, PharmaD2, Elisa Fugazza, MSc2, Federica Zingaro, PhD2, Ilaria Valentini, PhD3, Michele Basile, MSc3.
1Viatris, Rome, Italy, 2Viatris, Milan, Italy, 3ALTEMS Advisory, Catholic University of Sacred Heart, Rome, Italy.
1Viatris, Rome, Italy, 2Viatris, Milan, Italy, 3ALTEMS Advisory, Catholic University of Sacred Heart, Rome, Italy.
OBJECTIVES: To assess the cost-utility of standard-dose (SD) versus high-dose (HD) influenza vaccination in the Italian population aged 65 and older.
METHODS: A cost-utility analysis (CUA) was performed from the Italian NHS perspective over a one-year time horizon. The target population (~14.5 million) included individuals aged ≥65, stratified into three groups: 65-74, 75-84, and ≥85 years. The model featured four health states: no influenza, influenza without complications, with complications, and death. Vaccine effectiveness was considered by strain, and the relative effectiveness of the HD vs SD for influenza-like illness (ILI) and hospitalization was considered by age group. Clinical inputs (including utilities, complication rates, hospital stays) were derived from published sources. Vaccine costs (€22.14 for HD, €3.54 for SD) reflected average tender prices; hospitalization costs were based on national DRG tariffs. A probabilistic sensitivity analysis (PSA) and cost-effectiveness acceptability curve were conducted.
RESULTS: In the base-case analysis for the ≥65 population, standard-dose (SD) influenza vaccination led to a 46.3% cost reduction of €254.46 million (€294.67 million vs €549.13 million total costs) with a marginal - 0.5% QALY change (12,616,093 vs 12,679,074) which means - 0.004 QALYs on an average individual level. The resulting incremental cost-effectiveness ratio (ICER) was € 4,040.30 per QALY gained, below the accepted willingness-to-pay (WTP) threshold in Italy (€25,000-€40,000). Age-specific ICERs were €7,931, €2,650 and €2,828 respectively. The PSA showed that SD vaccination remained cost-effective in over 90% of simulations at a WTP of €10,000/QALY for the overall population, with age-specific probabilities ranging from approximately 80% in the 65-74 group to over 95% in the older cohorts.
CONCLUSIONS: SD vaccination is a cost-effective alternative to HD in the aged ≥65 years population, with minimal health trade-offs at the individual level. The resulting budget savings could be reinvested to improve vaccination uptake and overall public health outcomes.
METHODS: A cost-utility analysis (CUA) was performed from the Italian NHS perspective over a one-year time horizon. The target population (~14.5 million) included individuals aged ≥65, stratified into three groups: 65-74, 75-84, and ≥85 years. The model featured four health states: no influenza, influenza without complications, with complications, and death. Vaccine effectiveness was considered by strain, and the relative effectiveness of the HD vs SD for influenza-like illness (ILI) and hospitalization was considered by age group. Clinical inputs (including utilities, complication rates, hospital stays) were derived from published sources. Vaccine costs (€22.14 for HD, €3.54 for SD) reflected average tender prices; hospitalization costs were based on national DRG tariffs. A probabilistic sensitivity analysis (PSA) and cost-effectiveness acceptability curve were conducted.
RESULTS: In the base-case analysis for the ≥65 population, standard-dose (SD) influenza vaccination led to a 46.3% cost reduction of €254.46 million (€294.67 million vs €549.13 million total costs) with a marginal - 0.5% QALY change (12,616,093 vs 12,679,074) which means - 0.004 QALYs on an average individual level. The resulting incremental cost-effectiveness ratio (ICER) was € 4,040.30 per QALY gained, below the accepted willingness-to-pay (WTP) threshold in Italy (€25,000-€40,000). Age-specific ICERs were €7,931, €2,650 and €2,828 respectively. The PSA showed that SD vaccination remained cost-effective in over 90% of simulations at a WTP of €10,000/QALY for the overall population, with age-specific probabilities ranging from approximately 80% in the 65-74 group to over 95% in the older cohorts.
CONCLUSIONS: SD vaccination is a cost-effective alternative to HD in the aged ≥65 years population, with minimal health trade-offs at the individual level. The resulting budget savings could be reinvested to improve vaccination uptake and overall public health outcomes.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE308
Topic
Economic Evaluation, Epidemiology & Public Health
Disease
Vaccines