PharmacoEconomics Italian Research Articles

, Volume 15, Issue 3, pp 101–109 | Cite as

Valutazione economica del vaccino antinfluenzale adiuvato con virosomi in Italia nella popolazione anziana

  • R. Gasparini
  • C. Lucioni
  • S. Mazzi
  • D. Amicizia
  • D. Panatto
Article
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Economic evaluation of adiuvanted virosomal influenza vaccine in the elderly population in Italy

Abstract

According to WHO, seasonal influenza affects 5–15% of population. Its burden (hospitalizations and deaths) is particularly heavy on elderly people. The only effective means of combating influenza is vaccination, and adjuvanted vaccines optimize the immune response.

This work aims at evaluating the economic convenience of a virosomal vaccine in preventing hospitalization for influenza and pneumonia in the elderly in Italy; it is designed as a cost-benefit analysis, comparing vaccination costs with corresponding savings from hospitalization reduction. The analysis is based on a published case-control study performed in the elderly population (>64 years) residing in Genoa (Italy). The study period was the 2010–2011 season. A 95.2% vaccine effectiveness (p=0.004) was estimated.

The present analysis is conducted from the perspective of the National Health Service, at the whole country level. The vaccine cost was evaluated at discounted price and the hospitalizations with a weighted DRG tariff. Assuming to treat with a virosomal vaccine the Italian elderly population not covered (42%, i.e. 5,166,646 people), the campaign would cost €84.4 million (of which one third due to the cost of vaccine). Coeteris paribus, this strategy would prevent 41,280 hospitalizations, with savings amounting to €121.9 million—giving a net benefit of €37.5 million. A one-way sensitivity analysis (exploring: the uncertainty around the vaccine effectiveness; the herd immunity effect; a 75% coverage of the elderly population, corresponding to the Italian Ministry of Health target) substantially confirmed the favourable base case result, with net benefits ranging from −€4 million to €47.5 million.

Notes

Ringraziamenti

Lo studio è stato condotto grazie a un supporto incondizionato di Janssen-Cilag S.p.A.

Gli autori dichiarano di non avere conflitti di interesse relativi al contenuto del presente articolo.

Bibliografia

  1. 1.
    Nordin J, Mullooly J, Poblete S, et al. Influenza vaccine effectiveness in preventing hospitalizations and deaths in persons 65 years or older in Minnesota, New York, and Oregon: data from 3 health plans. J Infect Dis. 2001;184:665–70. PubMedCrossRefGoogle Scholar
  2. 2.
    World Health Organization. Influenza http://www.who.int/mediacentre/factsheets/2003/fs211/en/ [Accesso del 4/09/13].
  3. 3.
    Molinari N-AM, Ortega-Sanchez IR, Messonnier ML, et al. The annual impact of seasonal influenza in the US: measuring disease burden and costs. Vaccine. 2007;25:5086–96. PubMedCrossRefGoogle Scholar
  4. 4.
    Lucioni C, Costa B, Sessa A. I costi dell’influenza in Italia. FarmacoEconomia Percorsi Ter. 2001;2:11–8. Google Scholar
  5. 5.
    Montomoli E, Pozzi T, Alfonsi V, et al. Valutazione benefici-costi della vaccinazione antinfluenzale negli anziani in due stagioni epidemiche a confronto nella provincia di Siena. PharmacoEconomics—Ital Res Art. 2003; 5(Suppl 1):31–8. Google Scholar
  6. 6.
    Gasparini R, Lucioni C, Lai P, et al. Valutazione benefici-costi della vaccinazione antinfluenzale negli anziani in Liguria. PharmacoEconomics—Ital Res Art. 2003;5(Suppl 1):25–30. Google Scholar
  7. 7.
    Ministero dell’Economia e delle Finanze—Commissione Tecnica per la finanza pubblica. Libro verde sulla spesa pubblica. http://www.rgs.mef.gov.it/_Documenti/VERSIONE-I/Bilancio-d/Libro-verde-sulla-spesa-pubblica/Sanit-.pdf [Accesso del 28/10/13].
  8. 8.
    Francis T. Cultivation of human influenza virus in an artificial medium. Science. 1935;82:353–4. PubMedCrossRefGoogle Scholar
  9. 9.
    Burnet FM. Influenza virus infections of the chick embryo by the amniotic route. Aust J Exp Biol Med Sci. 1940;18:353–9. CrossRefGoogle Scholar
  10. 10.
    Jennings R, Clark A, Oxford JS, et al. Reactogenicity and immunogenicity of whole and ether-Tween-split influenza A virus vaccines in volunteers. J Infect Dis. 1978;138:577–86. PubMedCrossRefGoogle Scholar
  11. 11.
    Kunz C, Hofmann H, Bachmayer H, et al. Clinical trials with a new influenza subunit vaccine in adults and children. Dev Biol Stand. 1977;39:297–302. PubMedGoogle Scholar
  12. 12.
    Gasparini R, Lai P, Panatto D. Why an adjuvant is needed and how it works? Eur Infect Dis. 2010; 4:36–40. Google Scholar
  13. 13.
    Gasparini R, Lai P. Utility of virosomal adjuvanted influenza vaccines: a review of the literature. J Prev Med Hyg. 2010; 51:1–6. PubMedGoogle Scholar
  14. 14.
    Gasparini R, Amicizia D, Lai PL, et al. Effectiveness of adjuvanted seasonal influenza vaccines (Inflexal V® and Fluad®) in preventing hospitalization for influenza and pneumonia in the elderly: a matched case-control study. Hum Vaccin Immunother. 2013; 9:144–52. PubMedCrossRefGoogle Scholar
  15. 15.
    Talbot HK, Griffin MR, Chen Q, et al. Effectiveness of seasonal vaccine in preventing confirmed influenza-associated hospitalizations in community dwelling older adults. J Infect Dis. 2011; 203: 800–8. CrossRefGoogle Scholar
  16. 16.
    Castilla J, Martínez-Artola V, Salcedo E, et al. Network for influenza surveillance in hospitals of Navarre. Vaccine effectiveness in preventing influenza hospitalizations in Navarre, Spain, 2010–2011: cohort and case-control study. Vaccine. 2012;30:195–200. PubMedCrossRefGoogle Scholar
  17. 17.
    Ministero della Salute. Rapporto annuale sull’attività di ricovero ospedaliero—Dati SDO 2010. Primi 50 aggregati clinici di codici (ACC) diagnostici (ICD9 CM 2007) per numerosità di dimissioni—Attività per acuti in regime ordinario—Anno 2010. Google Scholar
  18. 18.
    ASCA Agenzia Stampa Quotidiana Nazionale—20 marzo 2012. http://www.asca.it/news-Salute__Polmonite_nemico_sottovalutato__causa_7mila_morti_l_anno-1136326.html [Accesso del 25/09/13].
  19. 19.
    Mantovani L, Cesana G, Fornari C, et al. Il burden delle polmoniti: analisi dai database amministrativi (DENALI) della Regione Lombardia. 45° Congresso Società Italiana Igiene, Medicina preventiva e Sanità Pubblica (SItI). 3–6 ottobre 2012. Santa Margherita di Pula (CA). Google Scholar
  20. 20.
    Sessa A, Seminara N, Bettoncelli G, Rossi A. Lo studio AQUARIUS: dati clinici generali sulle polmoniti acquisite in comunità. http://www.simg.it/Documenti/Rivista/2004/01_2004/4.pdf [Accesso del 12/07/13].
  21. 21.
    Drummond MF, Sculpher MJ, Torrance GW, et al. Methods for the economic evaluation of health care programmes. 3rd ed. Oxford: Oxford University Press; 2005. Google Scholar
  22. 22.
    Jansen, data on file (aggiudicazione gara Regione Liguria, stagione 2010–2011). Google Scholar
  23. 23.
    Mennini FS, Giorgi Rossi P, Palazzo F, Largeron N. Health and economic impact associated with a quadrivalent HPV vaccine in Italy. Gynecol Oncol. 2009; 112:370–6. PubMedCrossRefGoogle Scholar
  24. 24.
    Regione Liguria. Assessorato alla Sanità, data on file. Google Scholar
  25. 25.
    Conferenza delle Regioni e delle Province autonome. Accordo Interregionale per la compensazione della Mobilità Sanitaria. Versione in vigore per le attività dell’anno 2011. Roma, 22 maggio 2012. Tariffa Unica Convenzionale per le prestazioni di assistenza ospedaliera per acuti. Google Scholar
  26. 26.
    Ministero della Salute. Rapporto annuale sull’attività di ricovero ospedaliero—Dati SDO 2010. Descrizione dell’attività per DRG (versione 24)—Attività per acuti in regime ordinario—Anno 2010. Google Scholar
  27. 27.
    ISTAT. Annuario statistico italiano 2011. Popolazione residente per sesso ed età al 31 dicembre—Anno 2010. Google Scholar
  28. 28.
    Plans-Rubiò P. The vaccination coverage required to establish herd immunity against influenza viruses. Prev Med. 2012;55:72–7. PubMedCrossRefGoogle Scholar
  29. 29.
    CDC (Centers for Disease Control and Prevention). Respiratory Syncytial Virus Infection (RSV). http://www.cdc.gov/rsv/clinical/description.html [Accesso del 28/10/13].
  30. 30.
    Esper F, Martinello RA, Boucher D, et al. A 1-year experience with human metapneumovirus in children aged <5 years. J Infect Dis. 2004;189:1388–96. PubMedCrossRefGoogle Scholar
  31. 31.
    Iannazzo S. Pharmacoeconomic evaluation of the MF59—adjuvanted influenza vaccine in the elderly population in Italy. J Prev Med Hyg. 2011; 52:1–8. PubMedGoogle Scholar
  32. 32.
    Udell JA, Zawi R, Bhatt DL, et al. Association between influenza vaccination and cardiovascular outcomes in high-risk patients: a meta-analysis. JAMA. 2013;310:1711–20. PubMedCrossRefGoogle Scholar
  33. 33.
    Nichol KL, Nordin J, Mullooly J, et al. Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. N Engl J Med. 2003;348:1322–32. PubMedCrossRefGoogle Scholar
  34. 34.
    Pagine sanitarie on line http://www.paginesanitarie.com [Accesso del 24/07/13].
  35. 35.
    MacIntyre CR, Heywood AE, Pramesh Kovoor P, et al. Ischaemic heart disease, influenza and influenza vaccination: a prospective case control study. Heart Online First [Published on August 21, 2013]. doi: 10.1136/heartjnl-2013-304320.
  36. 36.
    Mauskopf J, Klesse M, Lee S, Herrera-Taracena G. The burden of influenza complications in different high-risk groups: a targeted literature review. J Med Econ. 2013;16:264–77. PubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • R. Gasparini
    • 1
  • C. Lucioni
    • 2
  • S. Mazzi
    • 2
  • D. Amicizia
    • 1
  • D. Panatto
    • 1
  1. 1.Dipartimento di Scienze della SaluteUniversità di GenovaGenovaItalia
  2. 2.Springer Healthcare Italia srlMilanoItalia

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