Cost-Effectiveness of Adjuvanted Versus Nonadjuvanted Influenza Vaccine in Adult Hemodialysis Patients

Lee BY, Stalter RM, Bacon KM, Tai JH, Bailey RR, Zimmer SM, Wagner MM. Cost-effectiveness of adjuvanted versus nonadjuvanted influenza vaccine in adult hemodialysis patients. Am J Kidney Dis. 2011 May;57(5):724-32. doi: 10.1053/j.ajkd.2010.12.016. Epub 2011 Mar 10. PMID: 21396760. PMCID: PMC3085888.


Currently, over 340,000 individuals are receiving long-term hemodialysis (HD) therapy for end-stage renal disease and therefore are particularly vulnerable to influenza, prone to more severe influenza outcomes, and less likely to achieve seroprotection from standard influenza vaccines. Influenza vaccine adjuvants, chemical or biological compounds added to a vaccine to boost the elicited immunological response, may help overcome this problem.

Study design

Economic stochastic decision analytic simulation model.

Setting & Participants

United States adult HD population.

Model, Perspective, & Timeframe

The model simulated the decision to use either an adjuvanted or non-adjuvanted vaccine, assumed the societal perspective, and represented a single influenza season, or 1 year.


Adjuvanted influenza vaccine at different adjuvant costs and efficacies. Sensitivity analyses explored the impact of varying the influenza clinical attack rate, influenza hospitalization rate, and influenza-related mortality.


Incremental cost-effectiveness ratio (ICER) of adjuvanted influenza vaccine (versus non-adjuvanted) with effectiveness measured in quality-adjusted life-years (QALYs).


Adjuvanted influenza vaccine would be cost-effective (ICER<$50,000/QALY) at a $1 adjuvant cost (on top of the standard vaccine cost) when the adjuvant efficacy (in overcoming the difference between influenza vaccine response in HD patients and healthy adults) ≥60% and economically dominant (provides both cost savings and health benefits) when the $1 adjuvant's efficacy is 100%. A $2 adjuvant would be cost-effective should the adjuvant efficacy be 100%.


All models are simplifications of real life and cannot possibly capture all possible factors and outcomes.


An adjuvanted influenza vaccine with adjuvant cost ≤$2 could be cost-effective strategy in a standard influenza season depending on the potency of the adjuvant.

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