This study uses a dynamic influenza transmission model to directly compare the cost-effectiveness of various policies of annual paediatric influenza vaccination in England and Wales, varying the target age range and level of coverage. The model accounts for both the protection of those immunised and the indirect protection of the rest of the population via herd immunity. The impact of augmenting current practice with a policy to vaccinate pre-school age children, on their own or with school age children, was assessed in terms of quality adjusted life years and health service costs. Vaccinating 2-18 year olds was estimated to be the most cost-effective policy in an incremental cost-effectiveness analysis, at an assumed annual vaccine uptake rate of 50%. The mean incremental cost-effectiveness ratios for this policy was estimated at £251/QALY relative to current practice. Paediatric vaccination would appear to be a highly cost-effective intervention that directly protects those targeted for vaccination, with indirect protection extending to both the very young and the elderly.
BackgroundTrivalent influenza vaccines encompass one influenza B lineage; however, predictions have been unreliable on which of two antigenically distinct circulating lineages will dominate. Quadrivalent seasonal influenza vaccines contain strains from both lineages. This analysis assesses the cost effectiveness of switching from trivalent inactivated influenza vaccination (TIV) in Finland to quadrivalent vaccination, using inactivated (QIV) or live-attenuated (Q-LAIV) vaccines.MethodsA transmission model simulated the dynamics of influenza infection while accounting for indirect (herd) protection. Prior distributions for key transmission parameters were repeatedly sampled and simulations that fitted the available information on influenza in Finland were recorded. The resulting posterior parameter distributions were used in a probabilistic sensitivity analysis in which economic parameters were sampled, simultaneously encompassing uncertainty in the transmission and economic parameters. The cost effectiveness of a range of trivalent and quadrivalent vaccine policies over a 20-year time horizon was assessed from both a societal and payer perspective in 2014 Euros.ResultsThe simulated temporal incidence pattern of symptomatic infections corresponded well with case surveillance data. A switch from the current TIV to Q-LAIV in children (2 to <18 years) and to QIV in other ages was estimated to annually avert approximately 76,100 symptomatic infections (95 % range 36,700–146,700), 11,500 primary care consultations (6100–20,000), 540 hospitalisations (240–1180), and 72 deaths (32–160), and was cost-saving relative to TIV (€374 million averted [€161–€752], in 2014 Euros, discounted at 3 %). This scenario had the highest probability of being the most cost-effective scenario considered.ConclusionsThis analysis demonstrates that quadrivalent vaccination is expected to be highly cost effective, reducing the burden of influenza-related disease.Electronic supplementary materialThe online version of this article (doi:10.1007/s40273-016-0430-z) contains supplementary material, which is available to authorized users.
matching data over [2000][2001][2002][2003][2004][2005][2006][2007][2008][2009][2010] 17,088 additional cases, 337 additional hospitalizations and 168 additional deaths could potentially be avoided annually with QIV versus TIV. There would be no additional benefits for well-matched years 2000-03 and 2009-10. In mismatched years benefits could range from minor, such as 2003-4 (100% mismatched, 0.4% influenza-B circulation) where 578 additional cases, 11 additional hospitalizations and 6 additional deaths potentially avoided to significant impact, such as 2005-6 (98.8% mismatched, 70% influenza-B circulation) with 100,296 additional cases, 1,976 additional hospitalizations and 988 additional deaths potentially avoided. CONCLUSIONS: Our analysis predicts that using recent influenza-B circulation and vaccine matching data, in 6 out of 10 years, a strategy of vaccination with QIV would have been more effective than TIV in reducing the number of influenza cases, and associated hospitalisations and deaths. Retrospective analysis of influenza circulation suggests that co-circulation of influenza-B lineages persists and that mismatch is frequent and unpredictable. The use of QIV might aid in reducing the associated burden of mismatched influenza-B.
Objectives: To estimate the general practitioner (GP) consultation rate attributable to influenza in The Netherlands.Methods: Regression analysis was performed on the weekly numbers of influenza-like illness (ILI) GP consultations and laboratory reports for influenza virus types A and B and 8 other pathogens over the period 2003-2014 (11 influenza seasons; week 40-20 of the following year).Results: In an average influenza season, 27% and 11% of ILI GP consultations were attributed to infection by influenza virus types A and B, respectively. Influenza is therefore responsible for approximately 107 000 GP consultations (651/100 000) each year in The Netherlands. GP consultation rates associated with influenza infection were highest in children under 5 years of age, at 667 of 100 000 for influenza A and 258 of 100 000 for influenza B. Influenza virus infection was found to be the predominant cause of ILI-related GP visits in all age groups except children under 5, in which respiratory syncytial virus (RSV) infection was found to be the main contributor. Conclusions:The burden of influenza in terms of GP consultations is considerable. Overall, influenza is the main contributor to ILI. Although ILI symptoms in children under 5 years of age are most often associated with RSV infection, the majority of visits related to influenza occur among children under 5 years of age.
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