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For Vaccines, Does Dose Matter?

October 21, 2015

High-dose flu vaccines result in fewer hospitalizations among older individuals, making them the more cost-effective choice compared to standard-dose vaccines.

Adults 65 years and older who suffer flu-related health complications cost the United States billions of dollars in hospitalization expenses, noted the study. The researchers set out to assess the cost-effectiveness of a high-dose vaccine to determine if it could relieve some of that significant economic burden associated with caring for older patients infected with the flu virus.

Their analysis used data from a large-scale, multi-center efficacy trial, in which a higher-dose split-virus inactivated influenza vaccine (Fluzone by Sanofi Pasteur) was compared to a standard-dose split-virus inactivated influenza vaccine in individuals 65 years and older, according to study lead author Dr. Ayman Chit, senior director of health economics, modeling and market access in North America at Sanofi Pasteur.

The vaccines were administered during the 2011-2012 and 2012-2013 flu seasons, according to the researchers, who noted the 2011-2012 season had a good match between vaccine and circulating strain and low influenza activity, while the more severe 2012-2013 season was known for a H3N2 strain that did not match the season’s vaccine.

The primary results from the efficacy trial showed that the high-dose vaccine was 24% more effective in preventing laboratory-confirmed influenza-like illness than the low-dose vaccine, according to Dr. Chit. In the current supplemental analysis of the trial, his research team used healthcare cost data to compare the economic impacts of the low-dose and high-dose vaccines.

“The findings showed that total healthcare payer costs ­— the combined costs of study vaccine, prescription drugs, emergency room visits, non-routine and urgent-care visits, and hospital admissions ­— were about $116 less per person,” said Dr. Chit.

According to the study, the high-dose vaccine was 93% more likely to result in cost-savings. In addition, said the researchers, health-care systems that incurred the $20 more it took to administer the high-dose vaccine on the front end earned a whopping 587% financial return — perhaps derived from fewer hospitalizations for treating cardiorespiratory infections.

The overall magnitude of the cost reduction observed in this analysis was larger than the researchers anticipated, according to Dr. Chit.

Sanofi Pasteur funded the research.

The study was published online in The Lancet Infectious Diseases.


—Dan Cook



1. Chit A, Becker DL, DiazGranados CA, Maschio M, Yau E, Drummond M. Cost-effectiveness of high-dose versus standard-dose inactivated influenza vaccine in adults aged 65 years and older: an economic evaluation of data from a randomised controlled trial. Lancet Infect Dis. 2015 Sep 8. [Epub ahead of print]

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