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Cost-utility of quadrivalent versus trivalent influenza vaccine in Brazil - comparison of outcomes from different static model types.

Identifieur interne : 000042 ( Main/Exploration ); précédent : 000041; suivant : 000043

Cost-utility of quadrivalent versus trivalent influenza vaccine in Brazil - comparison of outcomes from different static model types.

Auteurs : Laure-Anne Van Bellinghen [Belgique] ; Alen Marijam [Belgique] ; Gabriela Tannus Branco De Araujo [Brésil] ; Jorge Gomez [Argentine] ; Ilse Van Vlaenderen [Belgique]

Source :

RBID : pubmed:29352897

Descripteurs français

English descriptors

Abstract

BACKGROUND

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.

OBJECTIVE

To understand the impact of model complexity, the cost-utility of quadrivalent versus trivalent influenza vaccines 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).

METHODS

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.

RESULTS

Using the best data for each model, the discounted cost-utility ratio of quadrivalent versus trivalent influenza vaccine 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 in Analysis 2 versus 1, and a proportionally higher number of vaccinated elderly in FLORENCE reduced this ratio in Analysis 2.

DISCUSSION

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).

CONCLUSION

All three models predicted a cost per quality-adjusted life year gained for quadrivalent versus trivalent influenza vaccine in the range of R$19,257 (FLORENCE) to R$22,768 (FLORA) with the best available data in Brazil (Appendix A).


DOI: 10.1016/j.bjid.2017.11.004
PubMed: 29352897


Affiliations:


Links toward previous steps (curation, corpus...)


Le document en format XML

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<term>Cost-Benefit Analysis (statistics & numerical data)</term>
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<b>BACKGROUND</b>
</p>
<p>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.</p>
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<b>OBJECTIVE</b>
</p>
<p>To understand the impact of model complexity, the cost-utility of quadrivalent versus trivalent influenza vaccines 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).</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>METHODS</b>
</p>
<p>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.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>RESULTS</b>
</p>
<p>Using the best data for each model, the discounted cost-utility ratio of quadrivalent versus trivalent influenza vaccine 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 in Analysis 2 versus 1, and a proportionally higher number of vaccinated elderly in FLORENCE reduced this ratio in Analysis 2.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>DISCUSSION</b>
</p>
<p>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).</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>CONCLUSION</b>
</p>
<p>All three models predicted a cost per quality-adjusted life year gained for quadrivalent versus trivalent influenza vaccine in the range of R$19,257 (FLORENCE) to R$22,768 (FLORA) with the best available data in Brazil (Appendix A).</p>
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<MeshHeading>
<DescriptorName UI="D018803" MajorTopicYN="Y">Models, Economic</DescriptorName>
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<DescriptorName UI="D019057" MajorTopicYN="N">Quality-Adjusted Life Years</DescriptorName>
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<DescriptorName UI="D015203" MajorTopicYN="N">Reproducibility of Results</DescriptorName>
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<DescriptorName UI="D018570" MajorTopicYN="N">Risk Assessment</DescriptorName>
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<DescriptorName UI="D014611" MajorTopicYN="N">Vaccination</DescriptorName>
<QualifierName UI="Q000191" MajorTopicYN="Y">economics</QualifierName>
<QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName>
</MeshHeading>
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<DescriptorName UI="D055815" MajorTopicYN="N">Young Adult</DescriptorName>
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<Keyword MajorTopicYN="N">Brazil</Keyword>
<Keyword MajorTopicYN="N">Cost-effectiveness</Keyword>
<Keyword MajorTopicYN="N">Influenza</Keyword>
<Keyword MajorTopicYN="N">QIV</Keyword>
<Keyword MajorTopicYN="N">TIV</Keyword>
<Keyword MajorTopicYN="N">Vaccination</Keyword>
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<PubMedPubDate PubStatus="received">
<Year>2017</Year>
<Month>07</Month>
<Day>17</Day>
</PubMedPubDate>
<PubMedPubDate PubStatus="revised">
<Year>2017</Year>
<Month>11</Month>
<Day>10</Day>
</PubMedPubDate>
<PubMedPubDate PubStatus="accepted">
<Year>2017</Year>
<Month>11</Month>
<Day>14</Day>
</PubMedPubDate>
<PubMedPubDate PubStatus="pubmed">
<Year>2018</Year>
<Month>1</Month>
<Day>22</Day>
<Hour>6</Hour>
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<PubMedPubDate PubStatus="medline">
<Year>2018</Year>
<Month>3</Month>
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<Hour>6</Hour>
<Minute>0</Minute>
</PubMedPubDate>
<PubMedPubDate PubStatus="entrez">
<Year>2018</Year>
<Month>1</Month>
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<ArticleId IdType="pii">S1413-8670(17)30654-2</ArticleId>
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<li>Argentine</li>
<li>Belgique</li>
<li>Brésil</li>
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<li>État de São Paulo</li>
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<name sortKey="Van Bellinghen, Laure Anne" sort="Van Bellinghen, Laure Anne" uniqKey="Van Bellinghen L" first="Laure-Anne" last="Van Bellinghen">Laure-Anne Van Bellinghen</name>
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<name sortKey="Marijam, Alen" sort="Marijam, Alen" uniqKey="Marijam A" first="Alen" last="Marijam">Alen Marijam</name>
<name sortKey="Van Vlaenderen, Ilse" sort="Van Vlaenderen, Ilse" uniqKey="Van Vlaenderen I" first="Ilse" last="Van Vlaenderen">Ilse Van Vlaenderen</name>
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<region name="État de São Paulo">
<name sortKey="Tannus Branco De Araujo, Gabriela" sort="Tannus Branco De Araujo, Gabriela" uniqKey="Tannus Branco De Araujo G" first="Gabriela" last="Tannus Branco De Araujo">Gabriela Tannus Branco De Araujo</name>
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</country>
<country name="Argentine">
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<name sortKey="Gomez, Jorge" sort="Gomez, Jorge" uniqKey="Gomez J" first="Jorge" last="Gomez">Jorge Gomez</name>
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</record>

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