Estimation of the health impact and cost-effectiveness of influenza vaccination with enhanced effectiveness in Canada

PLoS One. 2011;6(11):e27420. doi: 10.1371/journal.pone.0027420. Epub 2011 Nov 14.


Introduction: The propensity for influenza viruses to mutate and recombine makes them both a familiar threat and a prototype emerging infectious disease. Emerging evidence suggests that the use of MF59-adjuvanted vaccines in older adults and young children enhances protection against influenza infection and reduces adverse influenza-attributable outcomes compared to unadjuvanted vaccines. The health and economic impact of such vaccines in the Canadian population are uncertain.

Methods: We constructed an age-structured compartmental model simulating the transmission of influenza in the Canadian population over a ten-year period. We compared projected health outcomes (quality-adjusted life years (QALY) lost), costs, and incremental cost-effectiveness ratios (ICERs) for three strategies: (i) current use of unadjuvanted trivalent influenza vaccine; (ii) use of MF59-adjuvanted influenza vaccine adults ≥65 in the Canadian population, and (iii) adjuvanted vaccine used in both older adults and children aged < 6.

Results: In the base case analysis, use of adjuvanted vaccine in older adults was highly cost-effective (ICER = $2111/QALY gained), but such a program was "dominated" by a program that extended the use of adjuvanted vaccine to include young children (ICER = $1612/QALY). Results were similar whether or not a universal influenza immunization program was used in other age groups; projections were robust in the face of wide-ranging sensitivity analyses.

Interpretation: Based on the best available data, it is projected that replacement of traditional trivalent influenza vaccines with MF59-adjuvanted vaccines would confer substantial benefits to vaccinated and unvaccinated individuals, and would be economically attractive relative to other widely-used preventive interventions.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Calibration
  • Canada
  • Child
  • Child, Preschool
  • Cost-Benefit Analysis
  • Health*
  • Humans
  • Infant
  • Infant, Newborn
  • Influenza Vaccines / economics*
  • Influenza Vaccines / immunology*
  • Influenza, Human / prevention & control
  • Influenza, Human / transmission
  • Middle Aged
  • Models, Biological*
  • Quality of Life
  • Time Factors
  • Vaccination / economics*
  • Vaccination / methods*
  • Vaccination / statistics & numerical data
  • Young Adult


  • Influenza Vaccines