Table 3

Key study outputs

StudyPopulationIntervention and comparatorNet health benefits (per patient)*Net costs (per patient)Incremental cost-effectiveness ratio*Headline results
Comparison of vaccination types
 Baio et al 23Unknown risk aged ≥65Adjuvanted vaccination vs standard vaccinationNR−€1.95Adjuvanted vaccine dominated standard vaccination (per death averted)Adjuvanted vaccine was shown to be cost-effective against the standard vaccine.
 Meier et al 24 Mixed risk aged ≥65 (48% high risk)Quadrivalent influenza vaccination vs trivalent influenza vaccinationNRNR€11 751 per QALYQuadrivalent vaccination is cost-effective compared with trivalent vaccination in the UK.
 Piercy et al (2004)25 High-risk elderly people aged ≥65Adjuvanted vaccination vs standard vaccination0.003397 fewer ILI cases, 0.000043 deaths avoided and 0.000300 LYG€1.31€30 503 per death avoided and €6131 per LYGResults were mixed according to the different scenarios for the strain of the influenza virus considered.
Comparison of vaccination strategies
 Allsup et al 26 Low risk aged 65–74Vaccination vs no intervention0.000007 fewer deaths and 0.000044 additional QALYs€ 5.37‡€3 576 908 per death avoided, €4 59 350 per life-year gained and €5 72 305 per QALY gainedInfluenza vaccination was judged not to be cost-effective in the low-risk elderly population.
 Baio et al 23Unknown risk aged ≥65Adjuvanted vaccination vs no interventionNR−€3.76Adjuvanted vaccine dominated no intervention (per death averted)Both vaccination types were cost-effective against no intervention.
 Standard vaccination vs no interventionNR−€1.91Standard vaccine dominated no intervention (per death averted)
 Brydak et al 29 Mixed risk aged ≥65 (50% high risk)Reimbursed vaccination vs no interventionNR€22.61€11 790 per QALY gained, €58 981 cost per death avoided and €6881 per life-year gainedIntroducing public funding of influenza vaccination for people aged 65 and older to increase coverage was cost-effective compared with the status quo.
 Lugner et al 30 Mixed risk aged ≥65 (73%–100% high risk)Vaccination versus no intervention (Germany)NR€13.22€1065 per QALY gained (direct costs) and dominant per QALY gained (indirect costs included)In general, vaccination was shown to be a cost-effective strategy. Early vaccination strategies are more favourable with lower total costs and cost per QALY gained. The inclusion of indirect costs makes the early vaccination strategies dominant in all countries.
 Vaccination vs no intervention (UK)NR€17.19€4621 per QALY gained (direct costs) and dominant per QALY gained (indirect costs included)
 Vaccination vs no intervention (Netherlands)NR€17.62€1338 per QALY gained (direct costs) and dominant per QALY gained (indirect costs included)
 Postma et al 28 Mixed risk aged ≥65 (35% high risk)Vaccination vs no interventionNRNR€2468 per LYG (all elderly people), €9355 per LYG (low risk) and dominant per LYG (high risk)Population-wide influenza vaccination for elderly people was found to be cost-effective. More favourable results were estimated in the high-risk population.
 Scuffham and West31 Unknown risk aged ≥65 or 60 (country differences)Opportunistic vaccination vs no intervention (England)0.547400 fewer morbidity days and 0.001040 LYG−€1.89Dominated per LYG gainedVaccination strategies were cost-effective vs no intervention.
 Comprehensive vaccination vs no intervention (England)1.065400 fewer morbidity days and 0.002020 LYG−€0.84Dominated per LYG
 Opportunistic vaccination vs no intervention (France)0.822500 fewer morbidity days and 0.001470 LYG€2.11€1437 per LYG
 Comprehensive vaccination vs no intervention (France)1.011300 fewer morbidity days and 0.001800 LYG€6.53€3623 per LYG
 Opportunistic vaccination vs no intervention (Germany)0.479500 fewer morbidity days and 0.000780 LYG€2.87€3676 per LYG
 Comprehensive vaccination vs no intervention (Germany)0.760200 fewer morbidity days and 0.001240 LYG€8.69€7016 per LYG
  • *Note that net benefit per person was calculated by the author where the total net benefits across the population and total population figures were provided by studies. This may mean that there appears to be differences between the incremental cost-effectiveness ratio value calculated by the study and the value calculated using the net benefit above, likely due to rounding differences.

  • †Note that the study by Baio et al 23 directly compared vaccination types, as well as comparing both vaccination types to no vaccination.23

  • ‡Trial cost only reported (not actual modelled costs).

  • ILI, influenza-like illness; LYG, life-years gained; NR, not reported; QALY, quality-adjusted life-year.