Cost-utility analysis of increasing uptake of universal seasonal quadrivalent influenza vaccine (QIV) in children aged 6 months and older in Germany

Figures & data

Figure 1. Model structure with epidemiologic (4Flu) and economic (e4Flu) pathways. Source: Adapted from Dolk et al.³¹ Abbreviations: AE, accident & emergency; GP, general practitioner; MA, medical advice; NI, neuraminidase inhibitor.

Table 1. Vaccination uptake rates (base case) and efficacy.

Age group	Reported uptake (%)	Calculated uptake (%)		Vaccine efficacy (%)
		Healthy	High-risk ^a
6 months–2 years	4.1^19,b	3.87^18,b	7.74^18,b	49.8^Citation35
3–8 years	4.1^19,b	3.87^18,b	7.74^18,b	55.4^Citation36
9–15 years	4.1^19,b	3.87^18,b	7.74^18,b	69.0^Citation37
16–17 years	4.1^19,b	3.59^18	7.18^18	63.0^Citation38,b
18–39 years	13.6^20	11.91^18	23.82^18	63.0^Citation38,b
40–59 years	22.2^20	19.44^18	38.88^18	63.0^Citation38,b
60–64 years	33.2^21,b	33.2^18,b	33.2^18,b	63.0^Citation38,b
65+ years	33.2^21,b	33.2^18,b	33.2^18,b	58.0^Citation39

^aProportion high-risk: 1–15 years (6.0%); 16–59 years (14.2%); >59 years (47.1%)²²; ^breported age group data (e.g., for age group 6 months to 17 years) applied to model age groups.

Table 2. Influenza burden, QALYs gained and incremental costs (3% discounted) over 20 years (per 100,000 population), and incremental costs per QALY gained by strategy versus the base case.

	All children			High-risk children
	Base case for A and B^a	Strategy A (40% uptake, 6m–4y)	Strategy B (40% uptake, 6m–17y)	Base case for C^a	Strategy C (90% uptake, HR 6m–17y)
Influenza cases	177,154	168,989	137,051	175,807	169,579
Reduction (%)		−8,165 (−4.6)	−40,103 (−22.6)		−6,228 (−3.5)
Influenza deaths	448	431	361	444	431
Reduction (%)		−17 (−3.8)	−87 (−19.4)		−13 (−2.9)
Hospitalizations	1,719	1,650	1,377	1,705	1,653
Reduction (%)		−69 (−4.0)	−342 (−19.9)		−52 (−3.0)
Complications	18,121	17,213	13,786	17,984	17,276
Reduction (%)		−908 (−5.0)	−4,335 (−23.9)		−708 (−3.9)
QALYs lost	4,207.06	4,041.64	3,360.03	4,174.10	4,045.68
QALYs gained		+165.42	+847.03		+128.42
Payer perspective (€, reimbursable medical/non-medical)
Vaccination costs	6,768,929	7,231,165	8,356,526	6,768,966	7,014,876
Influenza costs	8,364,143	7,902,975	6,279,774	8,302,969	7,973,380
Total Payer costs	15,133,072	15,134,140	14,636,299	15,071,935	14,988,256
Incremental cost		+1,068	−496,773		−83,679
Cost/QALY gained		6.46 <50k threshold	DOMINANT		DOMINANT
Societal perspective (€, Payer + non-reimbursable medical/non-medical and indirect)
Payer perspective	15,133,072	15,134,140	14,636,299	15,071,935	14,988,256
Vaccination costs	2,837,291	3,031,043	3,502,754	2,837,306	2,940,383
Influenza costs	1,445,977	1,379,083	1,120,291	1,435,440	1,384,519
Indirect costs	75,317,225	71,650,752	57,767,239	74,779,383	72,057,785
Total Societal costs	94,733,565	91,195,019	77,026,584	94,124,064	91,370,943
Incremental cost		−3,538,546	−17,706,981		−2,753,121
Cost/QALY gained		DOMINANT	DOMINANT		DOMINANT

^aThe first comparisons (Base case versus Strategy A and B) used the same random number sequence; while the second comparison (Base case versus Strategy C) used another random number sequence. As different random number sequences were used in the first and second comparison, the corresponding base case results differed slightly, reflecting the stochastic nature of the simulations (all results are arithmetic means of 1,000 simulations). Abbreviations: HR, high-risk; m, months; QALY, quality-adjusted life-year; y, years; €: Euro.

Table 3. Scenario analyses results.

	All children				High-risk children
	Base case for A and B^a	Strategy A (40% uptake, 6m-4y)	Strategy B (40% uptake, 6m-17y)	Base case for C^a		Strategy C (90% uptake, HR 6m-17y)
Scenario 1: QALYs discounted at 1%, costs at 3%
QALYs lost	5,613.34	5,401.05	4,505.19	5,567.86		5,399.02
QALY gain		+212.29	+1,108.15			+168.84
Total Payer costs	15,133,072	15,134,140	14,636,299	15,071,935		14,988,256
Incremental cost		+1,068	−496,773			−83,679
Cost/QALY		5.03 <€50k threshold	DOMINANT			DOMINANT
Total Societal costs	94,733,565	91,195,019	77,026,584	94,124,064		91,370,943
Incremental cost		−3,538,546	−17,706,981			−2,753,121
Cost/QALY		DOMINANT	DOMINANT			DOMINANT
Scenario 2: German baseline utility (no differentiation by risk status)
QALYs lost	4,312.86	4,142.46	3,442.61	4,279.15		4,147.23
QALY gain		+170.40	+870.25			+131.92
Total Payer costs	15,133,072	15,134,140	14,636,299	15,071,935		14,988,256
Incremental cost		+1,068	−496,773			−83,679
Cost/QALY		6.27 < €50k threshold	DOMINANT			DOMINANT
Total Societal costs	94,733,565	91,195,019	77,026,584	94,124,064		91,370,943
Incremental cost		−3,538,546	−17,706,981			−2,753,121
Cost/QALY		DOMINANT	DOMINANT			DOMINANT

^aSee explanations in Table 2. Abbreviations: HR, high-risk; m, months; QALY, quality-adjusted life-year; y, years; €: Euro.

Figure 2. Cost-Effectiveness plane (1,000 PSA runs per strategy) for a German population of 100,000 individuals over 20 years (a) Payer perspective, (b) Societal perspective.

Abbreviations: m, months; PSA, probabilistic sensitivity analysis; Q, quadrant; QALY, quality-adjusted life-year; WTP, willingness-to-pay; y, years.

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