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

Jean-Eric Tarride,^1,2 Natasha Burke,^1,2 Camilla Von Keyserlingk,^1,2 Daria O'Reilly,^1,2 Feng Xie,^1,2 Ron Goeree<sup>1,2

1</sup>Programs for Assessment of Technology in Health (PATH) Research Institute, St Joseph's Healthcare Hamilton, Hamilton, ²Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada

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