High Dose Influenza Vaccine for Adults: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Key Message

Three systematic reviews, four randomized controlled trials (RCTs), four economic evaluations, and one guideline were identified regarding high-dose influenza vaccination. For immunocompromised individuals, high-dose trivalent inactivated influenza vaccine (HD-IIV3) appeared to have no statistically significant difference in safety when compared to standard dose trivalent inactivated influenza vaccine (SD-IIV3). This evidence was very limited, with methodological concerns and different and heterogeneous populations for each study.For elderly adults 65 years of age or older, HD-IIV3 appeared to have similar or higher effectiveness at reducing influenza illnesses, hospitalization, and mortality, when compared to SD-IIV3, with no statistical differences in adverse events. HD-IIV3 also appeared to be cost effective from both a Canadian and US perspective, when compared to SD-IIV3, no vaccination, and standard dose quadrivalent IIV. One high-quality evidence based guideline was identified in the literature, recommending HD-IIV3 for elderly adults 65 or older over standard dose vaccines on an individual level. On a programmatic level, all vaccine strategies, including high dose, were recommended. There were no evidence based guidelines or cost-effectiveness studies focusing on immunocompromised populations.