Estimation of the Health Impact and Cost-Effectiveness of Influenza Vaccination with Enhanced Effectiveness in Canada 英文参考文献.docVIP

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Estimation of the Health Impact and Cost-Effectiveness of Influenza Vaccination with Enhanced Effectiveness in Canada 英文参考文献.doc

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Estimation of the Health Impact and Cost-Effectiveness of Influenza Vaccination with Enhanced Effectiveness in Canada 英文参考文献

EstimationoftheHealthImpactandCost-Effectiveness ofInfluenzaVaccinationwithEnhancedEffectivenessin Canada DavidN.Fisman*,AshleighR.Tuite DivisionofEpidemiology,DallaLanaSchoolofPublicHealth,UniversityofToronto,Toronto,Ontario,Canada Abstract Introduction: The propensity for influenza viruses to mutate and recombine makes them both a familiar threat and a prototype emerging infectious disease. Emerging evidence suggests that the use of MF59-adjuvanted vaccines in older adults and young children enhances protection against influenza infection and reduces adverse influenza-attributable outcomes compared to unadjuvanted vaccines. The health and economic impact of such vaccines in the Canadian populationareuncertain. Methods:Weconstructedanage-structuredcompartmentalmodelsimulatingthetransmissionofinfluenzaintheCanadian populationoveraten-yearperiod.Wecomparedprojectedhealthoutcomes(quality-adjustedlifeyears(QALY)lost),costs, and incremental cost-effectiveness ratios (ICERs) for three strategies: (i) current use of unadjuvanted trivalent influenza vaccine;(ii)useofMF59-adjuvantedinfluenzavaccineadults$65intheCanadianpopulation,and(iii)adjuvantedvaccine usedinbotholderadultsandchildrenaged,6. Results:Inthebasecaseanalysis,useofadjuvantedvaccineinolderadultswashighlycost-effective(ICER=$2111/QALY gained),butsuchaprogramwas‘‘dominated’’byaprogramthatextendedtheuseofadjuvantedvaccinetoincludeyoung children(ICER=$1612/QALY).Resultsweresimilarwhetherornotauniversalinfluenzaimmunizationprogramwasusedin otheragegroups;projectionswererobustinthefaceofwide-rangingsensitivityanalyses. Interpretation:Basedonthebestavailabledata,itisprojectedthatreplacementoftraditionaltrivalentinfluenzavaccines withMF59-adjuvantedvaccineswouldconfersubstantialbenefitstovaccinatedandunvaccinatedindividuals,andwould beeconomicallyattractiverelativetootherwidely-usedpreventiveinterventions. Citation: Fisman DN, Tuite AR (2011) Estimation of the Health Impact and Cost-Effectiveness of Influenza Vaccinat