Here we quantified the impact of a “diversified” (i.e. This is why the budget impact analysis (BIA) is increasingly required by reimbursement authorities as a part of a comprehensive economic evaluation of a technology. However, while the cost-effectiveness analysis allows the value comparison of different strategies, it cannot directly address the issues of the affordability and sustainability of such interventions. However, aTIV has the most favorable economic profile, being a highly cost-effective strategy compared with TIV and the dominant (both in terms of cost-saving and effectiveness) strategy compared with idTIV and QIV. It has been recently shown that all available vaccines are cost-effective in the elderly Italian population when compared with non-vaccination. For example, in some regions the vaccine acquisition price may be crucial, with TIV (as the “oldest” of the available alternatives) being the cheapest option. Several factors may have contributed to this inhomogeneity. Similarly to the “jeopardized” nature of influenza VC rates, the influenza vaccine mix is highly inhomogeneous among single regions. relative procurement distribution of single vaccine types) is changing continuously and partly reflects the evolving market situation (e.g. Procurement of influenza vaccines in Italy is based on regional tenders with four separate lots for the four aforementioned vaccine types. For instance, while TIV and QIV may be administered to all principal age-classes, aTIV and idTIV have been specifically developed for older adults in order to overcome the suppressive phenomenon of immunosenescence. These four vaccine formulations have different clinically important features, including age indication, route of administration, immunogenicity, vaccine effectiveness (VE), etc. In the last 2017/18 influenza season, four different vaccine types were available for immunization of the elderly, namely, trivalent inactivated vaccines (TIVs), MF59-adjuvanted TIV (aTIV), intradermal TIV (idTIV) and quadrivalent inactivated vaccines (QIV). Unlike vaccines against several other diseases, the market of influenza vaccines is significantly diverse. Each Region may then fully adopt the national recommendation or provide its own circular. Moreover, prior to the commencement of an influenza season, the Ministry of Health issues “Prevention and Control of Influenza” recommendations for a given season. Each Region then adopts its own immunization plan. In the context of the Italian fiscal federalism, the Ministry of Health periodically issues, following approval of the State-Regions Conference, National Immunization Prevention Plans (the last edition for 2017–2019) aimed at guiding and harmonizing immunization strategies across the regions. This figure may be exemplified by seasonal influenza VC rates among the elderly: in 2016/17 there was a 1.7-fold difference between regions, from 37.3% in South Tyrol to 63.1% in Umbria. VC rates among single Italian regions are often described as “jeopardized”. Both National and supranational authorities have recognized the value of influenza immunization among seniors and demand at least a 75% vaccination coverage (VC) or better still a 95% VC. Indeed, given that the elderly are the most affected population, all member states of the European Union recommend seasonal influenza immunization for this particularly vulnerable group. Vaccination remains the most important and effective public health measure able to dramatically reduce the large burden of seasonal influenza. In Italy, influenza is still the third largest cause of infectious disease-related mortality most influenza-attributable deaths occur in the elderly.
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