Optimization of Elderly Influenza and Pneumococcal Immunization Programs in Beijing, China Using Health Economic Evaluations: A Modeling Study
Abstract
:1. Introduction
2. Methods
2.1. Model Overview
2.2. Vaccination Strategies
2.3. Epidemiological and Clinical Inputs
2.4. Health State Utilities
2.5. Costs
2.6. Decision Rules
- Simulate costs and QALYs associated with each strategy;
- Sequence the strategies by costs in increasing order;
- Determine whether each strategy iss dominated by the next strategy starting from the least expensive strategy. Repeat this step, until there are no dominated strategies;
- Determine whether each strategy (e.g., strategy k) is extensively dominated by the next strategy by comparing the ICER of the next strategy (strategy k + 1) in relation to the previous strategy (strategy k − 1) to that of the running ICER (ICERs of strategy k vs. strategy k − 1). If the ICER of strategy k + 1 vs. k − 1 is smaller than the running ICER, then strategy k is extensively dominated. This is repeated, until there are no extensively dominated strategies;
- Identify the strategy with the ICER is immediately below the WTP threshold as the optimal strategy;
- If ICERs are not applicable, the NMB of the optimal strategy in reference to the current policy (strategy 3) is calculated.
2.7. Sensitivity Analyses
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Inputs | Base-Case Value | Value Change for OWSA | Distribution for PSA | Reference |
---|---|---|---|---|
Clinical inputs | ||||
Influenza vaccination rate | 0.19 | ±20% | beta | [21] |
Annual probability of influenza infection in the unvaccinated elderly | 0.23 | ±20% | beta | [22] |
Annual probability of IPD in the unvaccinated elderly per 100,000 | 8.3 | ±20% | beta | [25] |
Influenza vaccine effectiveness | 32% | ±20% | beta | [28] |
PPSV23 effectiveness | 50% | ±20% | beta | [29] |
PPSV23 serotype coverage | 0.77 | ±20% | beta | [30] |
Proportion of non-medically attended influenza | 0.34 | - | - | Estimated |
Proportion of outpatient influenza | 0.62 | ±20% | beta | [31] |
Proportion of hospitalized influenza | 0.04 | ±20% | beta | [31] |
Probability of hospitalized influenza patients to develop IPD | 0.10 | ±20% | beta | [19] |
Proportion of IPD patients to become disabled | 0.07 | ±20% | beta | [32] |
Probability of recovery from influenza hospitalization | 0.78 | - | - | Estimated |
Probability of recovery from IPD | 0.54 | - | - | Estimated |
Annual background mortality rate death per 1000 (60–64 years old) | 2.0 | ±20% | beta | [33] |
Annual probability of natural death per 1000 (70–74 years old) | 5.9 | ±20% | beta | [33] |
Probability of death from hospitalized influenza | 0.12 | ±20% | beta | [34] |
Probability of death from IPD | 0.16 | ±20% | beta | [35] |
Mortality ratio of the disabled | 1.1 | - | [19] | |
Utility scores | ||||
60–64 years old | 0.74 | ±10% | beta | [36] |
65–69 years old | 0.71 | ±10% | beta | |
70–74 years old | 0.69 | ±10% | beta | |
75–79 years old | 0.68 | ±10% | beta | |
80–84 years old | 0.66 | ±10% | beta | |
Utility decrement of non-medically attended influenza | 0.05 | ±10% | beta | Assumed |
Utility score of outpatient influenza | 0.61 | ±10% | beta | [37] |
Utility score of hospitalized influenza | 0.56 | ±10% | beta | [37] |
Utility score of IPD | 0.20 | ±10% | beta | [38] |
Utility score of disabled | 0.40 | ±10% | beta | [19] |
Duration | ||||
Length of non-medical/outpatient influenza (days) | 6.2 | - | - | [37] |
Length of hospitalized influenza (days) | 9 | ±20% | gamma | [39] |
Length of IPD (days) | 12 | ±20% | gamma | [40] |
Costs (2020 CNY) | ||||
Price of influenza vaccine per dose | 28 | ±20% | gamma | [41] |
Price of PPSV23 per dose | 200 | ±20% | gamma | [42] |
Vaccine administration costs per dose | 25 | ±20% | gamma | [21] |
Non-medically attended influenza cost | 100 | ±20% | gamma | Estimated |
Outpatient influenza cost | 421 | ±20% | gamma | [21] |
Hospitalized influenza cost | 15,870 | ±20% | gamma | [21] |
IPD hospitalization cost | 12,460 | ±20% | gamma | [40] |
Daily labor compensation rate in Beijing | 656 | ±20% | gamma | [43] |
Average life expectancy | ||||
60–64 years old | 21 | - | - | [33] |
70–74 years old | 13 | - | - | [33] |
Annual discount rate | 5% | - | - | [44] |
Strategy NO. | Strategy | Costs (CNY) | QALYs | ICER | NMB (CNY) |
---|---|---|---|---|---|
1 | No vaccination | 2746.1 | 8.900666 | Dominated * | NA |
2 | Flu vaccine for people ≥ 60 YO | 2589.2 | 8.905088 | Dominated * | NA |
3 | Flu vaccine for people ≥ 60 YO and PPSV23 for people ≥ 65 YO | 2585.0 | 8.905136 | Dominated * | Reference strategy |
4 | Both vaccines for people ≥ 60 YO | 2584.6 | 8.905139 | Optimal | 0.57 |
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Pi, Z.; Aoyagi, K.; Arima, K.; Wu, X.; Ye, Z.; Jiang, Y. Optimization of Elderly Influenza and Pneumococcal Immunization Programs in Beijing, China Using Health Economic Evaluations: A Modeling Study. Vaccines 2023, 11, 161. https://doi.org/10.3390/vaccines11010161
Pi Z, Aoyagi K, Arima K, Wu X, Ye Z, Jiang Y. Optimization of Elderly Influenza and Pneumococcal Immunization Programs in Beijing, China Using Health Economic Evaluations: A Modeling Study. Vaccines. 2023; 11(1):161. https://doi.org/10.3390/vaccines11010161
Chicago/Turabian StylePi, Zhenfei, Kiyoshi Aoyagi, Kazuhiko Arima, Xiaoliang Wu, Zhaojia Ye, and Yawen Jiang. 2023. "Optimization of Elderly Influenza and Pneumococcal Immunization Programs in Beijing, China Using Health Economic Evaluations: A Modeling Study" Vaccines 11, no. 1: 161. https://doi.org/10.3390/vaccines11010161
APA StylePi, Z., Aoyagi, K., Arima, K., Wu, X., Ye, Z., & Jiang, Y. (2023). Optimization of Elderly Influenza and Pneumococcal Immunization Programs in Beijing, China Using Health Economic Evaluations: A Modeling Study. Vaccines, 11(1), 161. https://doi.org/10.3390/vaccines11010161