Public health and budget impacts of switching from a trivalent to a quadrivalent inactivated influenza vaccine in Paraguay

Figures & data

Figure 1. Diagram of the retrospective module. QIV = quadrivalent influenza vaccine; TIV = trivalent influenza.

Figure 2. Diagram of the prospective module. QIV = quadrivalent influenza vaccine; TIV = trivalent influenza vaccine.

Table 1. Parameters with intervals for the sensitivity analysis to inform the model.

Parameters	Value	Interval for sensitivity analysis	Reference
Population size
6–35 months	494,400	N/A	National statistics,^Citation14
36 months to 19 years—HR	83,075
20–59 years -HR	748,102
≥60 years	720,211
Vaccination coverage, %			Unpublished data from the Ministry of Health
6–35 months	30.9%	Assumption ± 20%
36 months to 19 years—HR	24.8%
20–59 years -HR	25.1%
≥60 years	40.7%
Vaccine efficacy against influenza A, %			^Citation17
6–35 months	59.0%	[.41; .71]
36 months to 19 years—HR	60.9%	[.48; .70]
20–59 years -HR	61.0%	[.48; .70]
≥60 years	58.4%	[.38; .72]
Vaccine efficacy against matched B, %
6–35 months	66.0%	[.12; .53]
36 months to 19 years—HR	76.3%	[.12; .62]
20–59 years -HR	75.7%	[.12; .59]
≥60 years	66.9%	[.16; .53]
Vaccine efficacy against mismatched B ^a
6–35 months	44.0%	[.08; .82]
36 months to 19 years—HR	51.1%	[.19; .72]
20–59 years -HR	49.0%	[.12; .90]
≥60 years	44.6%	[.09; .85]
Vaccine cost, USD			Public prices^Citation36
TIV	5.14	Assumption ± 20%
QIV	2.65
Cost of vaccine administration, USD	1.22	Assumption ± 20%	^Citation33
Cost of GP visit, USD	54.1	Assumption ± 20%	^Citation32
Cost of hospitalization, USD	1,261.3	Assumption ± 20%
Workdays lost ^b,
6–35 months	2		Advisory board
36 months to 19 years—HR	2	Assumption ± 20%
20–59 years—HR	7
≥60 years	7
Daily wages, USD^c	12.7	N/A	^Citation35

HR = high risk; GP = general practitioner; QIV = quadrivalent influenza vaccine; TIV = trivalent influenza. vaccine.

For TIV only.

Productivity losses in children reflected those incurred by their caregivers.

Corrected by the employment rate.

Table 2. Costs and savings due to the replacement of TIV with QIV by seasons.

Measure	2012 season	2013 season	2014 season	2015 season	2016 season	2017 season	Total reference case	Total scenario analysis
% of mismatched cases	17.5%	11.2%	11.2%	5.9%	19.9%	27.9%
Number of additional events avoided:
Influenza cases	337	249	219	221	858	792	2,675	13,343
GP consultations	704	517	463	461	1,832	1,626	5,602	10,215
Workdays saved	1,721	1,332	1,112	1,176	4,374	4,516	14,230	38,263
Hospitalizations	7	10	6	5	19	22	67	234
Deaths	1	2	1	1	3	3	10	29
Costs saved, USD
GP consultations	38,087	27,977	25,064	24,921	99,119	87,980	303,149	552,757
Hospitalizations	8,606	12,006	7,018	5,973	23,567	27,267	84,437	295,012
Productivity losses	189,475	126,255	111,465	109,102	349,302	333,196	60,925	285,062
Costs saved, payer perspective, USD	46,693	39,983	32,082	30,894	122,687	115,247	387,585	847,769
Costs saved, societal perspective, USD	236,168	166,238	143,547	139,996	471,988	448,443	448,511	1,132,830

GP = general practitioner; QIV = quadrivalent influenza vaccine; TIV = trivalent influenza vaccine.

Figure 3. Tornado diagrams (societal perspective). GP = general practitioner; QIV = quadrivalent influenza vaccine; TIV = trivalent influenza vaccine; Yam = Yamagata.

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