Estimated Health and Economic Impact of Using High-dose Influenza Vaccine on Respiratory and Circulatory Plus Respiratory Hospitalizations of Older Adults in Australia

Overview

Journal Vaccine X

Date 2023 Aug 23

PMID 37609557

Authors

C Raina MacIntyre

J Kevin Yin

Christian Felter

Robert I Menzies

Edward Thommes

Nathalie Largeron

Aye M Moa

Mallory Trent

Valentina Costantino

Seulki Choi

Fabian P Alvarez

Affiliations

Soon will be listed here.

Abstract

Background: Standard dose influenza vaccine provides moderate protection from infection, but with lower effectiveness among the elderly. High dose and adjuvanted vaccines (HD-TIV and aTIV) were developed to address this. This study aims to estimate the incremental health and economic impact of using HD-TIV (high dose trivalent vaccine) instead of aTIV (adjuvanted trivalent vaccine) on respiratory and circulatory plus respiratory hospitalizations of older people (≥65 years) in Australia.

Methods: This is a modelling study comparing predicted hospitalization outcomes in people receiving HD-TIV or aTIV during an average influenza season in Australia. Hospitalization records of Australian adults ≥65 years of age from 01 April to 30 November during 15 influenza seasons (2002-2017 excluding 2009, which was a pandemic) were extracted from the Australian Institute of Health and Welfare [AIHW] and used to calculate hospitalisation rates during an average season. Relative vaccine effectiveness data for aTIV and HD-TIV were used to estimate morbidity burden related to influenza.

Results: Between 2002 and 2017, the average respiratory hospitalization rate among older people during influenza season (April-November) was 3,445/100,000 population-seasons, with an average cost of AU$ 7,175 per admission. The average circulatory plus respiratory hospitalization rate among older Australian people during that time was 10,393/100,000 population-seasons, with an average cost of AU$ 7829 per admission. For older Australians, HD-TIV may avert an additional 6,315-9,410 respiratory admissions each year, with an incremental healthcare cost saving of AU$ 15.9-38.2 million per year compared to aTIV. Similar results were also noted for circulatory plus respiratory hospitalizations.

Conclusions: From the modelled estimations, HD-TIV was associated with less economic burden and fewer respiratory, and circulatory plus respiratory hospitalizations than aTIV for older Australians.

References

DiazGranados C, Dunning A, Kimmel M, Kirby D, Treanor J, Collins A . Efficacy of high-dose versus standard-dose influenza vaccine in older adults. N Engl J Med. 2014; 371(7):635-45. DOI: 10.1056/NEJMoa1315727. View

Sheridan S, Patel C, Macartney K, Cheng A . New enhanced influenza vaccines for older Australians: what promise do they hold?. Med J Aust. 2018; 209(3):110-112. DOI: 10.5694/mja18.00334. View

Gravenstein S, Davidson H, Taljaard M, Ogarek J, Gozalo P, Han L . Comparative effectiveness of high-dose versus standard-dose influenza vaccination on numbers of US nursing home residents admitted to hospital: a cluster-randomised trial. Lancet Respir Med. 2017; 5(9):738-746. DOI: 10.1016/S2213-2600(17)30235-7. View

Peasah S, Azziz-Baumgartner E, Breese J, Meltzer M, Widdowson M . Influenza cost and cost-effectiveness studies globally--a review. Vaccine. 2013; 31(46):5339-48. DOI: 10.1016/j.vaccine.2013.09.013. View

Iuliano A, Roguski K, Chang H, Muscatello D, Palekar R, Tempia S . Estimates of global seasonal influenza-associated respiratory mortality: a modelling study. Lancet. 2017; 391(10127):1285-1300. PMC: 5935243. DOI: 10.1016/S0140-6736(17)33293-2. View

DiazGranados C, Robertson C, Talbot H, Landolfi V, Dunning A, Greenberg D . Prevention of serious events in adults 65 years of age or older: A comparison between high-dose and standard-dose inactivated influenza vaccines. Vaccine. 2015; 33(38):4988-93. DOI: 10.1016/j.vaccine.2015.07.006. View

Warren-Gash C, Smeeth L, Hayward A . Influenza as a trigger for acute myocardial infarction or death from cardiovascular disease: a systematic review. Lancet Infect Dis. 2009; 9(10):601-10. DOI: 10.1016/S1473-3099(09)70233-6. View

Sellers S, Hagan R, Hayden F, Fischer 2nd W . The hidden burden of influenza: A review of the extra-pulmonary complications of influenza infection. Influenza Other Respir Viruses. 2017; 11(5):372-393. PMC: 5596521. DOI: 10.1111/irv.12470. View

van Aalst R, Gravenstein S, Mor V, Mahmud S, Wilschut J, Postma M . Comparative effectiveness of high dose versus adjuvanted influenza vaccine: A retrospective cohort study. Vaccine. 2019; 38(2):372-379. DOI: 10.1016/j.vaccine.2019.09.105. View

10.

McElhaney J . Influenza vaccine responses in older adults. Ageing Res Rev. 2010; 10(3):379-88. PMC: 3061971. DOI: 10.1016/j.arr.2010.10.008. View

11.

Frobert O, Gotberg M, Erlinge D, Akhtar Z, Christiansen E, MacIntyre C . Influenza Vaccination After Myocardial Infarction: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial. Circulation. 2021; 144(18):1476-1484. DOI: 10.1161/CIRCULATIONAHA.121.057042. View

12.

de Courville C, Cadarette S, Wissinger E, Alvarez F . The economic burden of influenza among adults aged 18 to 64: A systematic literature review. Influenza Other Respir Viruses. 2022; 16(3):376-385. PMC: 8983919. DOI: 10.1111/irv.12963. View

13.

Newall A, Scuffham P . Influenza-related disease: the cost to the Australian healthcare system. Vaccine. 2008; 26(52):6818-23. DOI: 10.1016/j.vaccine.2008.09.086. View

14.

Kelly H, Sullivan S, Grant K, Fielding J . Moderate influenza vaccine effectiveness with variable effectiveness by match between circulating and vaccine strains in Australian adults aged 20-64 years, 2007-2011. Influenza Other Respir Viruses. 2012; 7(5):729-37. PMC: 5781205. DOI: 10.1111/irv.12018. View

15.

Mattock R, Gibbons I, Moss J, Mealing S, Largeron N, Carroll S . Cost-effectiveness of high dose versus adjuvanted trivalent influenza vaccines in England and Wales. J Med Econ. 2021; 24(1):1261-1271. DOI: 10.1080/13696998.2021.2000780. View

16.

Lee J, Lam G, Shin T, Samson S, Greenberg D, Chit A . Efficacy and effectiveness of high-dose influenza vaccine in older adults by circulating strain and antigenic match: An updated systematic review and meta-analysis. Vaccine. 2021; 39 Suppl 1:A24-A35. DOI: 10.1016/j.vaccine.2020.09.004. View

17.

Domnich A, Arata L, Amicizia D, Puig-Barbera J, Gasparini R, Panatto D . Effectiveness of MF59-adjuvanted seasonal influenza vaccine in the elderly: A systematic review and meta-analysis. Vaccine. 2016; 35(4):513-520. DOI: 10.1016/j.vaccine.2016.12.011. View

18.

Lee J, Lam G, Shin T, Kim J, Krishnan A, Greenberg D . Efficacy and effectiveness of high-dose versus standard-dose influenza vaccination for older adults: a systematic review and meta-analysis. Expert Rev Vaccines. 2018; 17(5):435-443. DOI: 10.1080/14760584.2018.1471989. View

19.

Meier G, Watkins J, McEwan P, Pockett R . Resource use and direct medical costs of acute respiratory illness in the UK based on linked primary and secondary care records from 2001 to 2009. PLoS One. 2020; 15(8):e0236472. PMC: 7410242. DOI: 10.1371/journal.pone.0236472. View

20.

Dyda A, Karki S, Hayen A, MacIntyre C, Menzies R, Banks E . Influenza and pneumococcal vaccination in Australian adults: a systematic review of coverage and factors associated with uptake. BMC Infect Dis. 2016; 16(1):515. PMC: 5037616. DOI: 10.1186/s12879-016-1820-8. View