Economic evaluation of seasonal influenza vaccination in elderly and health workers: A systematic review and meta-analysis

Piyameth Dilokthornsakul, Le My Lan, Ammarin Thakkinstian, Raymond Hutubessy, Philipp Lambach, Nathorn Chaiyakunapruk, Piyameth Dilokthornsakul, Le My Lan, Ammarin Thakkinstian, Raymond Hutubessy, Philipp Lambach, Nathorn Chaiyakunapruk

Abstract

Background: A number of cost-effectiveness analysis of influenza vaccination have been conducted to estimate value of influenza vaccines in elderly and health workers (HWs). This study aims to summarize cost-effectiveness evidence by pooling the incremental net monetary benefit (INMB) of influenza vaccination.

Methods: A systematic review was performed in electronic databases from their inceptions to February 2022. Cost-effectiveness studies reporting quality-adjusted life year (QALY), or life year (LY) of influenza vaccination were included. Stratified meta-analyses by population, perspective, country income-level, and herd-effect were performed to pool INMB across studies. The protocol was registered at PROSPERO (CRD42021246746).

Findings: A total of 21 studies were included. Eighteen studies were conducted in elderly, two studies were conducted in HWs, and one study was conducted in both elderly and HWs. According to pre-specified analyses, studies for elderly in high-income economies (countries) (HIEs) and upper-middle income economies (UMIEs) without herd effect could be pooled. For HIEs under a societal perspective, the perspective which identify all relevant costs occurred in the society including direct medical cost, direct non-medical cost and indirect cost, pooled INMB was $217·38 (206·23, 228·53, I2 =28.2%), while that for healthcare provider/payer perspective was $0·20 (-11,908·67, 11,909·07, I2 = 0.0%). For societal perspective in UMIEs, pooled INMB was $28·39 (-190·65, 133·87, I2 = 92.8%). The findings were robust across a series of sensitivity analyses for HIEs. Studies in HWs indicated that influenza vaccination was cost-effective compared to no vaccination or current practice.

Interpretation: Influenza vaccination might be cost-effective for HWs and elderly in HIEs under a societal perspective with relatively small variations among included studies, while there remains limited evidence for healthcare provider/payer perspective or other level of incomes. Further evidence is warranted.

Funding: This study was funded by a grant of Immunization, Vaccine and Biologicals department of the World Health Organization. The authors would like to acknowledge the contributions of the US CDC which provided financial support to the development and publication of this report. Grant number US CDC, WHO IVR (U50CK000431).

Keywords: Cost-effectiveness; Economic evaluation; Influenza vaccination; Systematic review, Meta-analysis.

Conflict of interest statement

PD, LML, AT, and NC declare no competing interest. RH and PL work the World Health Organization. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy or views of the World Health Organization.

© 2022 Published by Elsevier Ltd.

Figures

Figure 1
Figure 1
A flow diagram of selection of studies. Abbreviations: CEA; cost-effectiveness analysis, CUA; cost-utility analysis, HCWs; health workers, HIE; high income economies, NoV; no vaccination, UMIE; upper-middle income economies.
Figure 2
Figure 2
Meta-analysis of influenza vaccination compared to no vaccination in elderly under societal perspective in high-income economies Note: Dashed line indicated the pooled estimate in a comparison with individual study estimates. p < .05 indicates statistical significance Abbreviations: AMR; Regions of the Americas, CI; confidence interval, INB; Incremental net monetary benefit, WPR; Western Pacific Region.
Figure 3
Figure 3
Meta-analysis of influenza vaccination compared to no vaccination in elderly under healthcare provider/pay perspective in high-income economies. Note: Dashed line indicated the pooled estimate in a comparison with individual study estimates. p < .05 indicates statistical significance. Abbreviations: AMR; Regions of the Americas, CI; confidence interval, EUR; European region, INB; Incremental net monetary benefit, WPR; Western Pacific Region.
Figure 4
Figure 4
Meta-analysis of influenza vaccination compared to no vaccination in elderly for societal perspective in upper-middle income economies. Note: Dashed line indicated the pooled estimate in a comparison with individual study estimates. p < .05 indicates statistical significance. Abbreviations: AFR; African region, AMR; Regions of the Americas, CI; confidence interval, INB; Incremental net monetary benefit.

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Source: PubMed

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