tetano
Editor, Senior Moderator
Vaccine
. 2020 Dec 4;S0264-410X(20)31282-2.
doi: 10.1016/j.vaccine.2020.10.007. Online ahead of print.
Cost-effectiveness of live-attenuated influenza vaccination among school-age children
Natasha S Wenzel[SUP] 1 [/SUP], Katherine E Atkins[SUP] 2 [/SUP], Edwin van Leeuwen[SUP] 3 [/SUP], M Elizabeth Halloran[SUP] 4 [/SUP], Marc Baguelin[SUP] 5 [/SUP]
Affiliations
Abstract
The current pediatric vaccination program in England and Wales administers Live-Attenuated Influenza Vaccine (LAIV) to children ages 2-16 years old. Annual administration of LAIV to this age group is costly and poses substantial logistical issues. This study aims to evaluate the cost-effectiveness of prioritizing vaccination to age groups within the 2-16 year old age range to mitigate the operational and resource challenges of the current strategy. We performed economic evaluations comparing the influenza vaccination program from 1995-2013 to seven alternative strategies targeted at low risk individuals along the school age divisions Preschool (2-4 years old), Primary school (5-11 years old), and Secondary school (12-16 years old). These extensions are evaluated incrementally on the status quo scenario (vaccinating subgroups at high risk of influenza-related complications and individuals 65+ years old). Impact of vaccination was assessed using a transmission model from a previously published study and updated with new data. At all levels of coverage, all strategies had a 100% probability of being cost-effective at the current National Health Service threshold, ?20,000/QALY gained. The incremental analysis demonstrated vaccinating Primary School children was the most cost-efficient strategy compared incrementally against others with an Incremental Cost-Effectiveness Ratio of ?639 spent per QALY gained (Net Benefit: 404 M? [155, 795]). When coverage was varied between 30%, 55%, and 70% strategies which included Primary school children had a higher probability of being cost-effective at lower willingness-to-pay levels. Although children were the vaccine target the majority of QALY gains occurred in the 25-44 years old and 65+ age groups. Influenza strain A/H3N2 incurred the greatest costs and QALYs lost regardless of which strategy was used. Improvement could be made to the current LAIV pediatric vaccination strategy by eliminating vaccination of 2-4 year olds and focusing on school-based delivery to Primary and Secondary school children in tandem.
Keywords: Adolescents; Children; Cost-effectiveness analysis; Influenza; Mathematical model; Paediatric vaccination; Seasonal influenza.
. 2020 Dec 4;S0264-410X(20)31282-2.
doi: 10.1016/j.vaccine.2020.10.007. Online ahead of print.
Cost-effectiveness of live-attenuated influenza vaccination among school-age children
Natasha S Wenzel[SUP] 1 [/SUP], Katherine E Atkins[SUP] 2 [/SUP], Edwin van Leeuwen[SUP] 3 [/SUP], M Elizabeth Halloran[SUP] 4 [/SUP], Marc Baguelin[SUP] 5 [/SUP]
Affiliations
- PMID: 33280855
- DOI: 10.1016/j.vaccine.2020.10.007
Abstract
The current pediatric vaccination program in England and Wales administers Live-Attenuated Influenza Vaccine (LAIV) to children ages 2-16 years old. Annual administration of LAIV to this age group is costly and poses substantial logistical issues. This study aims to evaluate the cost-effectiveness of prioritizing vaccination to age groups within the 2-16 year old age range to mitigate the operational and resource challenges of the current strategy. We performed economic evaluations comparing the influenza vaccination program from 1995-2013 to seven alternative strategies targeted at low risk individuals along the school age divisions Preschool (2-4 years old), Primary school (5-11 years old), and Secondary school (12-16 years old). These extensions are evaluated incrementally on the status quo scenario (vaccinating subgroups at high risk of influenza-related complications and individuals 65+ years old). Impact of vaccination was assessed using a transmission model from a previously published study and updated with new data. At all levels of coverage, all strategies had a 100% probability of being cost-effective at the current National Health Service threshold, ?20,000/QALY gained. The incremental analysis demonstrated vaccinating Primary School children was the most cost-efficient strategy compared incrementally against others with an Incremental Cost-Effectiveness Ratio of ?639 spent per QALY gained (Net Benefit: 404 M? [155, 795]). When coverage was varied between 30%, 55%, and 70% strategies which included Primary school children had a higher probability of being cost-effective at lower willingness-to-pay levels. Although children were the vaccine target the majority of QALY gains occurred in the 25-44 years old and 65+ age groups. Influenza strain A/H3N2 incurred the greatest costs and QALYs lost regardless of which strategy was used. Improvement could be made to the current LAIV pediatric vaccination strategy by eliminating vaccination of 2-4 year olds and focusing on school-based delivery to Primary and Secondary school children in tandem.
Keywords: Adolescents; Children; Cost-effectiveness analysis; Influenza; Mathematical model; Paediatric vaccination; Seasonal influenza.