Live Attenuated Influenza Vaccination (LAIV) for the Prevention of Influenza Illness in Sweden: A Cost-Effectiveness Analysis
Author(s)
Fryderyk Wilczynski, PhD1, Holly Prudden, PhD1, Sara Hallberg, MSc2, Åsa Tormod, MSc3, Mikko Tuovinen, MSc4, Amy Zhou, PhD5, Klas Bergenheim, PhD6.
1Health Economics and Outcomes Research Ltd., Cardiff, United Kingdom, 2Nordic Health Technology Assessment, AstraZeneca, Gothenburg, Sweden, 3Market Access Manager, AstraZeneca, Stockholm, Sweden, 4Nordic Health Technology Assessment, AstraZeneca, Helsinki, Finland, 5Global Pricing and Market Access, Vaccine and Immune Therapies, AstraZeneca, Cambridge, United Kingdom, 6Health Economics & Payer Evidence, Vaccine and Immune Therapies, AstraZeneca, Gothenburg, Sweden.
1Health Economics and Outcomes Research Ltd., Cardiff, United Kingdom, 2Nordic Health Technology Assessment, AstraZeneca, Gothenburg, Sweden, 3Market Access Manager, AstraZeneca, Stockholm, Sweden, 4Nordic Health Technology Assessment, AstraZeneca, Helsinki, Finland, 5Global Pricing and Market Access, Vaccine and Immune Therapies, AstraZeneca, Cambridge, United Kingdom, 6Health Economics & Payer Evidence, Vaccine and Immune Therapies, AstraZeneca, Gothenburg, Sweden.
OBJECTIVES: Inactivated influenza vaccine (IIV) and live attenuated influenza vaccine (LAIV) are effective for prevention of influenza-related illness. LAIV, delivered intranasally, is indicated in Europe for children aged 2-17. The standard of care (SoC) in Sweden (population size, 10.5 million), is to vaccinate adults >65 years and high-risk individuals. This study assesses the public health impact and cost-effectiveness of expanding vaccination via implementation of LAIV in children (aged 2-17 years; 25% coverage), the age group with highest rates of transmission. The analysis also evaluates the additional benefits of vaccinating this group on the indirect population (aged <2 and >17 years), including older adults at highest risk of complications and mortality.
METHODS: A de novo disease transmission model employing an SEIR (susceptible-exposed-infected-recovered) structure was used to evaluate coverage expansion. The prevalence of three influenza strains (A/H1N1, A/H2N3, B/Victoria) were modelled across an “average” (2014-2020) season for a 1-year time horizon. A decision tree model utilised modelled infection incidence to estimate case rate, resource usage, and mortality.
RESULTS: Vaccinating an additional 439,500 children (SoC: 874,500; intervention: 1,314,000) with LAIV prevents a further 598,000 influenza infections, of which 197,000 are prevented in the target population, and 401,000 in the indirect population. The intervention is cost-effective at a willingness-to-pay threshold of 500,000 kr/QALY (€45,590/QALY), with an incremental cost-effectiveness ratio (ICER) of 109,160 kr/QALY (€9,953/QALY). When productivity losses (workdays lost) are included, the intervention is cost saving (less expensive and more effective; ICER, -75,455 kr/QALY [-€6,880/QALY]). The intervention generally remains cost-effective for high and low prevalence seasons and variations in strain distribution.
CONCLUSIONS: LAIV is highly cost-effective in 2-17-year-olds by reducing disease burden and healthcare costs. When considering a societal perspective, LAIV is cost saving. Two thirds of preventable infections occur in the vulnerable indirect populations. Achieving high, consistent LAIV coverage ensures greater security against adverse influenza-related outcomes.
METHODS: A de novo disease transmission model employing an SEIR (susceptible-exposed-infected-recovered) structure was used to evaluate coverage expansion. The prevalence of three influenza strains (A/H1N1, A/H2N3, B/Victoria) were modelled across an “average” (2014-2020) season for a 1-year time horizon. A decision tree model utilised modelled infection incidence to estimate case rate, resource usage, and mortality.
RESULTS: Vaccinating an additional 439,500 children (SoC: 874,500; intervention: 1,314,000) with LAIV prevents a further 598,000 influenza infections, of which 197,000 are prevented in the target population, and 401,000 in the indirect population. The intervention is cost-effective at a willingness-to-pay threshold of 500,000 kr/QALY (€45,590/QALY), with an incremental cost-effectiveness ratio (ICER) of 109,160 kr/QALY (€9,953/QALY). When productivity losses (workdays lost) are included, the intervention is cost saving (less expensive and more effective; ICER, -75,455 kr/QALY [-€6,880/QALY]). The intervention generally remains cost-effective for high and low prevalence seasons and variations in strain distribution.
CONCLUSIONS: LAIV is highly cost-effective in 2-17-year-olds by reducing disease burden and healthcare costs. When considering a societal perspective, LAIV is cost saving. Two thirds of preventable infections occur in the vulnerable indirect populations. Achieving high, consistent LAIV coverage ensures greater security against adverse influenza-related outcomes.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE567
Topic
Clinical Outcomes, Economic Evaluation, Epidemiology & Public Health
Topic Subcategory
Work & Home Productivity - Indirect Costs
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Vaccines