tetano
Editor, Senior Moderator
Vaccine
. 2022 Jan 31;S0264-410X(22)00039-1.
doi: 10.1016/j.vaccine.2022.01.015. Online ahead of print.
Health and economic impact of seasonal influenza mass vaccination strategies in European settings: A mathematical modelling and cost-effectiveness analysis
Frank G Sandmann[SUP] 1 [/SUP], Edwin van Leeuwen[SUP] 2 [/SUP], Sibylle Bernard-Stoecklin[SUP] 3 [/SUP], Itziar Casado[SUP] 4 [/SUP], Jesús Castilla[SUP] 4 [/SUP], Lisa Domegan[SUP] 5 [/SUP], Alin Gherasim[SUP] 6 [/SUP], Mariëtte Hooiveld[SUP] 7 [/SUP], Irina Kislaya[SUP] 8 [/SUP], Amparo Larrauri[SUP] 6 [/SUP], Daniel Levy-Bruhl[SUP] 3 [/SUP], Ausenda Machado[SUP] 8 [/SUP], Diogo F P Marques[SUP] 9 [/SUP], Iván Martínez-Baz[SUP] 4 [/SUP], Clara Mazagatos[SUP] 6 [/SUP], Jim McMenamin[SUP] 9 [/SUP], Adam Meijer[SUP] 10 [/SUP], Josephine L K Murray[SUP] 9 [/SUP], Baltazar Nunes[SUP] 8 [/SUP], Joan O'Donnell[SUP] 5 [/SUP], Arlene Reynolds[SUP] 9 [/SUP], Dominic Thorrington[SUP] 11 [/SUP], Richard Pebody[SUP] 12 [/SUP], Marc Baguelin[SUP] 13 [/SUP]
Affiliations
Abstract
Introduction: Despite seasonal influenza vaccination programmes in most countries targeting individuals aged ≥ 65 (or ≥ 55) years and high risk-groups, significant disease burden remains. We explored the impact and cost-effectiveness of 27 vaccination programmes targeting the elderly and/or children in eight European settings (n = 205.8 million).
Methods: We used an age-structured dynamic-transmission model to infer age- and (sub-)type-specific seasonal influenza virus infections calibrated to England, France, Ireland, Navarra, The Netherlands, Portugal, Scotland, and Spain between 2010/11 and 2017/18. The base-case vaccination scenario consisted of non-adjuvanted, non-high dose trivalent vaccines (TV) and no universal paediatric vaccination. We explored i) moving the elderly to "improved" (i.e., adjuvanted or high-dose) trivalent vaccines (iTV) or non-adjuvanted non-high-dose quadrivalent vaccines (QV); ii) adopting mass paediatric vaccination with TV or QV; and iii) combining the elderly and paediatric strategies. We estimated setting-specific costs and quality-adjusted life years (QALYs) gained from the healthcare perspective, and discounted QALYs at 3.0%.
Results: In the elderly, the estimated numbers of infection per 100,000 population are reduced by a median of 261.5 (range across settings: 154.4, 475.7) when moving the elderly to iTV and by 150.8 (77.6, 262.3) when moving them to QV. Through indirect protection, adopting mass paediatric programmes with 25% uptake achieves similar reductions in the elderly of 233.6 using TV (range: 58.9, 425.6) or 266.5 using QV (65.7, 477.9), with substantial health gains from averted infections across ages. At €35,000/QALY gained, moving the elderly to iTV plus adopting mass paediatric QV programmes provides the highest mean net benefits and probabilities of being cost-effective in all settings and paediatric coverage levels.
Conclusion: Given the direct and indirect protection, and depending on the vaccine prices, model results support a combination of having moved the elderly to an improved vaccine and adopting universal paediatric vaccination programmes across the European settings.
Keywords: Economic evaluation; Influenza; Mathematical model; Policy; Public health; Vaccination.
. 2022 Jan 31;S0264-410X(22)00039-1.
doi: 10.1016/j.vaccine.2022.01.015. Online ahead of print.
Health and economic impact of seasonal influenza mass vaccination strategies in European settings: A mathematical modelling and cost-effectiveness analysis
Frank G Sandmann[SUP] 1 [/SUP], Edwin van Leeuwen[SUP] 2 [/SUP], Sibylle Bernard-Stoecklin[SUP] 3 [/SUP], Itziar Casado[SUP] 4 [/SUP], Jesús Castilla[SUP] 4 [/SUP], Lisa Domegan[SUP] 5 [/SUP], Alin Gherasim[SUP] 6 [/SUP], Mariëtte Hooiveld[SUP] 7 [/SUP], Irina Kislaya[SUP] 8 [/SUP], Amparo Larrauri[SUP] 6 [/SUP], Daniel Levy-Bruhl[SUP] 3 [/SUP], Ausenda Machado[SUP] 8 [/SUP], Diogo F P Marques[SUP] 9 [/SUP], Iván Martínez-Baz[SUP] 4 [/SUP], Clara Mazagatos[SUP] 6 [/SUP], Jim McMenamin[SUP] 9 [/SUP], Adam Meijer[SUP] 10 [/SUP], Josephine L K Murray[SUP] 9 [/SUP], Baltazar Nunes[SUP] 8 [/SUP], Joan O'Donnell[SUP] 5 [/SUP], Arlene Reynolds[SUP] 9 [/SUP], Dominic Thorrington[SUP] 11 [/SUP], Richard Pebody[SUP] 12 [/SUP], Marc Baguelin[SUP] 13 [/SUP]
Affiliations
- PMID: 35109968
- DOI: 10.1016/j.vaccine.2022.01.015
Abstract
Introduction: Despite seasonal influenza vaccination programmes in most countries targeting individuals aged ≥ 65 (or ≥ 55) years and high risk-groups, significant disease burden remains. We explored the impact and cost-effectiveness of 27 vaccination programmes targeting the elderly and/or children in eight European settings (n = 205.8 million).
Methods: We used an age-structured dynamic-transmission model to infer age- and (sub-)type-specific seasonal influenza virus infections calibrated to England, France, Ireland, Navarra, The Netherlands, Portugal, Scotland, and Spain between 2010/11 and 2017/18. The base-case vaccination scenario consisted of non-adjuvanted, non-high dose trivalent vaccines (TV) and no universal paediatric vaccination. We explored i) moving the elderly to "improved" (i.e., adjuvanted or high-dose) trivalent vaccines (iTV) or non-adjuvanted non-high-dose quadrivalent vaccines (QV); ii) adopting mass paediatric vaccination with TV or QV; and iii) combining the elderly and paediatric strategies. We estimated setting-specific costs and quality-adjusted life years (QALYs) gained from the healthcare perspective, and discounted QALYs at 3.0%.
Results: In the elderly, the estimated numbers of infection per 100,000 population are reduced by a median of 261.5 (range across settings: 154.4, 475.7) when moving the elderly to iTV and by 150.8 (77.6, 262.3) when moving them to QV. Through indirect protection, adopting mass paediatric programmes with 25% uptake achieves similar reductions in the elderly of 233.6 using TV (range: 58.9, 425.6) or 266.5 using QV (65.7, 477.9), with substantial health gains from averted infections across ages. At €35,000/QALY gained, moving the elderly to iTV plus adopting mass paediatric QV programmes provides the highest mean net benefits and probabilities of being cost-effective in all settings and paediatric coverage levels.
Conclusion: Given the direct and indirect protection, and depending on the vaccine prices, model results support a combination of having moved the elderly to an improved vaccine and adopting universal paediatric vaccination programmes across the European settings.
Keywords: Economic evaluation; Influenza; Mathematical model; Policy; Public health; Vaccination.