Health and economic impact of seasonal influenza mass vaccination strategies in European settings : a mathematical modelling and cost-effectiveness analysis
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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.
Sandmann , F G , van Leeuwen , E , Bernard-Stoecklin , S , Casado , I , Castilla , J , Domegan , L , Gherasim , A , Hooiveld , M , Kislaya , I , Larrauri , A , Levy-Bruhl , D , Machado , A , Marques , D F P , Martínez-Baz , I , Mazagatos , C , McMenamin , J , Meijer , A , Murray , J L K , Nunes , B , O'Donnell , J , Reynolds , A , Thorrington , D , Pebody , R & Baguelin , M 2022 , ' Health and economic impact of seasonal influenza mass vaccination strategies in European settings : a mathematical modelling and cost-effectiveness analysis ' , Vaccine , vol. 40 , no. 9 , pp. 1306-1315 . https://doi.org/10.1016/j.vaccine.2022.01.015
Copyright 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
DescriptionThis study was conducted as part of the I-MOVE+ (Integrated Monitoring of Vaccines in Europe) project, which had received a grant from the European Commission Horizon 2020 research and innovation programme (grant agreement No 634446). MB also thanks the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Modelling Methodology at Imperial College London in partnership with UK Health Security Agency (UKHSA) for funding (grant HPRU-2012–10080).
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