Object-oriented influence diagram for cost–effectiveness analysis of influenza vaccination in the Italian elderly population

Influenza infection is a major cause of illness, morbidity and mortality throughout the world, mainly amongst the elderly. Since vaccination has proven to be effective in the reduction of all acute complications, deciding whether to implement a vaccination campaign and which vaccine to prescribe is an important task. The aim of this review is to build a decision model, which allows the decision makers to evaluate the possible results under different scenarios, and to choose the decision associated with the highest expected utility. The analysis is based on Bayesian networks methodology. Vaccination is more effective in the long run and is cost saving compared with the null option. Moreover, the innovative MF59 adjuvanted flu vaccine proves to be cost effective with respect to standard vaccines.

[1]  Cécile Viboud,et al.  Antibody response to influenza vaccination in the elderly: a quantitative review. , 2006, Vaccine.

[2]  L. Sticchi,et al.  Neutralizing and Hemagglutination-Inhibiting Activities of Antibodies Elicited by the 2004-2005 Influenza Vaccine against Drifted Viruses , 2006, Clinical and Vaccine Immunology.

[3]  V Demicheli,et al.  Efficacy and effectiveness of influenza vaccines in elderly people: a systematic review , 2005, The Lancet.

[4]  Cécile Viboud,et al.  Influenza Vaccination Among the Elderly in the United States—Reply , 2005 .

[5]  J. McElhaney,et al.  The unmet need in the elderly: designing new influenza vaccines for older adults. , 2005, Vaccine.

[6]  A. Grau,et al.  Influenza Vaccination Is Associated With a Reduced Risk of Stroke , 2005, Stroke.

[7]  M. Sculpher,et al.  Probabilistic sensitivity analysis for NICE technology assessment: not an optional extra. , 2005, Health economics.

[8]  A. Iob,et al.  Evidence of increased clinical protection of an MF59-adjuvant influenza vaccine compared to a non-adjuvant vaccine among elderly residents of long-term care facilities in Italy , 2005, Epidemiology and Infection.

[9]  Cecile Viboud,et al.  Impact of influenza vaccination on seasonal mortality in the US elderly population. , 2005, Archives of internal medicine.

[10]  J. Díez-Domingo,et al.  Effectiveness of the MF59-adjuvanted influenza vaccine in preventing emergency admissions for pneumonia in the elderly over 64 years of age. , 2004, Vaccine.

[11]  B. Armstrong,et al.  Effect of influenza vaccination on excess deaths occurring during periods of high circulation of influenza: cohort study in elderly people , 2004, BMJ : British Medical Journal.

[12]  J. Piercy,et al.  Economic evaluation of MF59 adjuvanted vaccine against influenza in the high-risk elderly population in France , 2004 .

[13]  R. Ravasio,et al.  Valutazione benefici-costi della vaccinazione antinfluenzale negli anziani in due stagioni epidemiche a confronto nella provincia di Siena , 2003 .

[14]  K. Nichol,et al.  The efficacy, effectiveness and cost-effectiveness of inactivated influenza virus vaccines. , 2003, Vaccine.

[15]  A. Podda,et al.  A New MF59-Adjuvanted Influenza Vaccine Enhances the Immune Response in the Elderly with Chronic Diseases: Results from an Immunogenicity Meta-Analysis , 2003, Gerontology.

[16]  John Mullooly,et al.  Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. , 2003, The New England journal of medicine.

[17]  Eric R. Ziegel,et al.  Modeling in Medical Decision Making , 2002, Technometrics.

[18]  P A West,et al.  Economic evaluation of strategies for the control and management of influenza in Europe. , 2002, Vaccine.

[19]  Trang Vu,et al.  A meta-analysis of effectiveness of influenza vaccine in persons aged 65 years and over living in the community. , 2002, Vaccine.

[20]  C W Potter,et al.  A history of influenza , 2001, Journal of applied microbiology.

[21]  A. Floreani,et al.  Comparison of three different influenza vaccines in institutionalised elderly. , 2001, Vaccine.

[22]  A. Podda.  The adjuvanted influenza vaccines with novel adjuvants: experience with the MF59-adjuvanted vaccine. , 2001, Vaccine.

[23]  K. Nichol,et al.  Cost-benefit analysis of a strategy to vaccinate healthy working adults against influenza. , 2001, Archives of internal medicine.

[24]  M. Faccini,et al.  Safety and immunogenicity of MF59-adjuvanted influenza vaccine in the elderly. , 1999, Vaccine.

[25]  V. Baldo,et al.  Influenza vaccines: Antibody responses to split virus and MF59-adjuvanted subunit virus in an adult population , 1999, European Journal of Epidemiology.

[26]  K Claxton,et al.  The irrelevance of inference: a decision-making approach to the stochastic evaluation of health care technologies. , 1999, Journal of health economics.

[27]  Ross D. Shachter,et al.  Representation and Analysis of Medical Decision Problems with Influence Diagrams , 1997, Medical decision making : an international journal of the Society for Medical Decision Making.

[28]  Peter Szolovits.  Uncertainty and Decisions in Medical Informatics , 1995, Methods of Information in Medicine.

[29]  Prakash P. Shenoy,et al.  A comparison of graphical techniques for decision analysis , 1994 .

[30]  Frank Jensen,et al.  From Influence Diagrams to junction Trees , 1994, UAI.

[31]  David J. Spiegelhalter,et al.  Bayesian analysis in expert systems , 1993 .

[32]  Judea Pearl,et al.  Probabilistic reasoning in intelligent systems - networks of plausible inference , 1991, Morgan Kaufmann series in representation and reasoning.

[33]  Ross D. Shachter,et al.  A Bayesian Method for Synthesizing Evidence: The Confidence Profile Method , 1990, International Journal of Technology Assessment in Health Care.

[34]  Simon French,et al.  Readings in Decision Analysis , 1989 .

[35]  M. A. Best.  Bayesian Approaches to Clinical Trials and Health‐Care Evaluation , 2005 .

[36]  M. Zappa,et al.  Effectiveness of influenza vaccination in the elderly in a community in Italy , 2004, European Journal of Epidemiology.

[37]  A. Podda,et al.  Safety and immunogenicity of an inactivated subunit influenza virus vaccine combined with MF59 adjuvant emulsion in elderly subjects, immunized for three consecutive influenza seasons. , 1999, Vaccine.

[38]  Owen P. Hall,et al.  Readings in Decision Analysis , 1991 .