Cost-effectiveness analysis of intranasal live attenuated vaccine (LAIV) versus injectable inactivated influenza vaccine (TIV) for Canadian children and adolescents

Abstract

Background

Influenza affects all age groups and is common in children. Between 15% and 42% of preschool- and school-aged children experience influenza each season. Recently, intranasal live attenuated influenza vaccine, trivalent (LAIV) has been approved in Canada.

Objective

The objective of this study was to determine the cost-effectiveness of LAIV compared with that of the injectable inactivated influenza vaccine, trivalent (TIV) in Canadian children and adolescents from both a payer (eg. Ministry of Health) perspective and a societal perspective.

Methods

A cost-effectiveness model comparing LAIV and TIV in children aged 24–59 months old was supplemented by primary (ie, a survey of 144 Canadian physicians) and secondary (eg, literature) data to model children aged 2–17 years old. Parameter uncertainty was addressed through univariate and probability analyses.

Results

Although LAIV increased vaccination costs when compared to TIV, LAIV reduced the number of influenza cases and lowered the number of hospitalizations, emergency room visits, outpatient visits, and parents’ days lost from work. The estimated offsets in direct and societal costs saved were CAD$4.20 and CAD$35.34, respectively, per vaccinated child aged 2–17 years old. When costs and outcomes were considered, LAIV when compared to TIV, was the dominant strategy. At a willingness to pay of CAD$50,000 per quality adjusted life year gained, or CAD$100,000 per quality adjusted life year gained, the probabilistic results indicated that the probability of LAIV being cost-effective was almost 1.

Conclusions

LAIV reduces the burden of influenza in children and adolescents. Consistent with previously reported results, vaccinating children with LAIV, rather than TIV, is the dominant strategy from both a societal perspective and a Ministry of Health perspective.

Keywords:

• influenza
• vaccine
• children
• cost-effectiveness

Acknowledgments

This study was funded through an unrestricted grant from AstraZeneca Canada. At the time of study, Drs Daria O’Reilly, Jean-Eric Tarride, and Feng Xie were recipients of Career Scientist Awards from the Ontario Ministry of Health and Long-term Care. Since May 28, 2012 Jean-Eric Tarride’s primary affiliation has been with AstraZeneca Canada, Ontario, Canada.

Disclosure

The authors report no conflicts of interest in this work.