The potential cost-effectiveness of quadrivalent versus trivalent influenza vaccine in elderly people and clinical risk groups in the UK: a lifetime multi-cohort model

PLoS One. 2014 Jun 6;9(6):e98437. doi: 10.1371/journal.pone.0098437. eCollection 2014.


Objective: To estimate the potential cost-effectiveness of quadrivalent influenza vaccine compared with trivalent influenza vaccine in the UK.

Methods: A lifetime, multi-cohort, static Markov model was constructed, with nine age groups each divided into healthy and at-risk categories. Influenza A and B were accounted for separately. The model was run in one-year cycles for a lifetime (maximum age: 100 years). The analysis was from the perspective of the UK National Health Service. Costs and benefits were discounted at 3.5%. 2010 UK vaccination policy (vaccination of people at risk and those aged ≥65 years) was applied. Herd effect was not included. Inputs were derived from national databases and published sources where possible. The quadrivalent influenza vaccine price was not available when the study was conducted. It was estimated at £6.72,15% above the trivalent vaccine price of £5.85. Sensitivity analyses used an incremental price of up to 50%.

Results: Compared with trivalent influenza vaccine, the quadrivalent influenza vaccine would be expected to reduce the numbers of influenza cases by 1,393,720, medical visits by 439,852 complications by 167,357, hospitalisations for complications by 26,424 and influenza deaths by 16,471. The estimated base case incremental cost-effectiveness ratio (ICER) was £5,299/quality-adjusted life-year (QALY). Sensitivity analyses indicated that the ICER was sensitive to changes in circulation of influenza virus subtypes and vaccine mismatch; all other parameters had little effect. In 96% of simulations the ICER was <£20,000/QALY. Since this analysis was completed, quadrivalent influenza vaccine has become available in the UK at a list price of £9.94. Using this price in the model, the estimated ICER for quadrivalent compared with trivalent vaccination was £27,378/QALY, still within the NICE cost-effectiveness threshold (£20,000-£30,000).

Conclusions: Quadrivalent influenza vaccine could reduce influenza disease burden and would be cost-effective compared with trivalent influenza vaccine in elderly people and clinical risk groups in the UK.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Cost-Benefit Analysis*
  • Humans
  • Infant
  • Influenza Vaccines / adverse effects
  • Influenza Vaccines / economics*
  • Influenza Vaccines / therapeutic use
  • Middle Aged
  • Models, Economic*
  • Risk
  • United Kingdom


  • Influenza Vaccines

Grant support

The authors disclose the following direct or indirect financial relationships with the sponsors: Genevieve Meier is an employee of the GlaxoSmithKline group of companies and holds restricted shares in the GlaxoSmithKline group of companies; Ilse Van Vlaenderen's and Laure-Anne Van Bellinghen's institution received consulting fees from the GlaxoSmithKline group of companies for conducting the present study and has also received consultancy fees from the GlaxoSmithKline group of companies for other projects and for writing manuscript outlines related to these other projects. This study, including preparation of the manuscript, was funded by GlaxoSmithKline Biologicals SA, which was involved in: design and operation of the model; data inputs, analysis and interpretation; manuscript preparation, review and decision to submit for publication.