The cost-effectiveness of trivalent and quadrivalent influenza vaccination in communities in South Africa, Vietnam and Australia

Vaccine. 2018 Feb 8;36(7):997-1007. doi: 10.1016/j.vaccine.2017.12.073. Epub 2018 Jan 17.


Background: To inform national healthcare authorities whether quadrivalent influenza vaccines (QIVs) provide better value for money than trivalent influenza vaccines (TIVs), we assessed the cost-effectiveness of TIV and QIV in low-and-middle income communities based in South Africa and Vietnam and contrasted these findings with those from a high-income community in Australia.

Methods: Individual based dynamic simulation models were interfaced with a health economic analysis model to estimate the cost-effectiveness of vaccinating 15% of the population with QIV or TIV in each community over the period 2003-2013. Vaccination was prioritized for HIV-infected individuals, before elderly aged 65+ years and young children. Country or region-specific data on influenza-strain circulation, clinical outcomes and costs were obtained from published sources. The societal perspective was used and outcomes were expressed in International$ (I$) per quality-adjusted life-year (QALY) gained.

Results: When compared with TIV, we found that QIV would provide a greater reduction in influenza-related morbidity in communities in South Africa and Vietnam as compared with Australia. The incremental cost-effectiveness ratio of QIV versus TIV was estimated at I$4183/QALY in South Africa, I$1505/QALY in Vietnam and I$80,966/QALY in Australia.

Conclusions: The cost-effectiveness of QIV varied between communities due to differences in influenza epidemiology, comorbidities, and unit costs. Whether TIV or QIV is the most cost-effective alternative heavily depends on influenza B burden among subpopulations targeted forvaccination in addition to country-specific willingness-to-pay thresholds and budgetary impact.

Keywords: Cost-effectiveness; Dynamic transmission model; Influenza; Quadrivalent; Trivalent; Vaccination.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Australia / epidemiology
  • Community Health Services*
  • Cost-Benefit Analysis*
  • Female
  • Humans
  • Influenza Vaccines / administration & dosage
  • Influenza Vaccines / immunology*
  • Influenza, Human / epidemiology
  • Influenza, Human / prevention & control*
  • Influenza, Human / transmission
  • Male
  • Models, Theoretical
  • Monte Carlo Method
  • Outcome Assessment, Health Care
  • Public Health Surveillance
  • Socioeconomic Factors
  • South Africa / epidemiology
  • Vaccination*
  • Vietnam / epidemiology


  • Influenza Vaccines