Is the High-dose Flu Vaccine More Effective for Seniors, Including the PACE Population?

Adults age 65 and older, including those in the PACE population, are susceptible to serious complications from the influenza, or flu, virus. In the United States, flu complications among seniors cost a staggering $56 billion annually, mainly driven by costs related to hospital admissions and death. This large clinical and economic burden has long motivated influenza vaccine manufacturers to pursue the development of an improved annual influenza vaccine for older adults. [Tweet “In the United States, flu complications among seniors cost a staggering $56 billion annually.”]
One such vaccine, the trivalent inactivated influenza vaccine Fluzone High-Dose was licensed in the United States in 2009, and was subsequently shown to offer improvements in efficacy and effectiveness compared with standard-dose influenza vaccine in adults age 65 and older.

The Efficacy of the High-dose Vaccine in the PACE Population

The efficacy of the high-dose vaccine was shown in the randomized controlled FIM12 study, in which a total of 31,989 participants were enrolled from 126 research centers in the United States and Canada.
The results of this study demonstrated that among those age 65 years or older, Fluzone High-Dose induced significantly higher antibody responses and provided better protection against laboratory-confirmed influenza illness than Fluzone Standard-Dose.

Comparative effectiveness was shown by investigators from the US Food and Drug Administration, the Centers for Disease Control and Prevention, and the Centers for Medicare & Medicaid Services, who reported that the high-dose vaccine was 22 percent more effective than the standard-dose vaccine for the prevention of probable influenza disease. It was also 22 percent more effective for prevention of influenza-related emergency department visits and hospital admissions, both important factors to consider among PACE participants.

The Cost of High-dose Flu Vaccine Among Seniors, Including the PACE Population

The next key public health question for the high-dose vaccine concerns its cost-effectiveness: What role could the vaccine have in reducing the substantial economic burden of influenza in adults age 65 and older?
In one cost-analysis study, the findings show that the high-dose trivalent inactivated influenza vaccine is a cost-saving alternative to the standard-dose vaccine. More specifically, the additional cost of administering high-dose instead of standard-dose vaccine yielded a 587 percent financial return to the healthcare system alone.

Most of the savings were driven by reductions in cardiorespiratory hospital admissions plausibly related to influenza. As such, the results of the study suggest that the high-dose vaccine was cost saving over the analyzed 2-year period, and therefore had a better cost-effectiveness proposition than most other strategies used in the prevention of infectious disease.
Only one other study has performed this type of analysis, also demonstrating the cost-effectiveness of the high-dose vaccine when compared to the standard-dose vaccine.

Though upfront costs for the high-dose trivalent inactivated influenza vaccine are higher than the standard-dose vaccine, results of cost analysis have been majorly in favor of the high-dose vaccine, mainly driven by a reduction in the number of hospital admissions.

With patient-centered care in mind, PACE providers must consider the well-being of the participant as well as cost savings when recommending immunizations during the coming flu season.

Seniors, including PACE participants, have unique and specialized needs. Our Grane Rx team of geriatric-specialized pharmacists understands those challenges and works with PACE centers to overcome them. Partner with us today by calling (412) 449-0504.]]>

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