Cost-effectiveness of childhood influenza vaccination in England and Wales: Results from a dynamic transmission model

Abstract

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.

Targeted vaccination in healthy school children – Can primary school vaccination alone control influenza?

“…Previous modelling analyses demonstrating the costeffectiveness of vaccinating healthy children have consistently assumed that children in both primary schools (aged 4-11 years) and secondary schools (11-16 years) would be simultaneously vaccinated [18,19]. For infectious diseases such as seasonal influenza, which has a low potential for transmission, it is possible to vaccinate a proportion of a population to eliminate the potential for sustained transmission (the threshold for "herd immunity" [20]).…”

Dynamic modelling approaches for the analysis of the cost-effectiveness of seasonal influenza control

“…The aim of this study was to determine whether a vaccination program in either primary (age 4-11 years) or secondary (age 11-16 years) schools would be more costeffective than a single vaccination program across both age groups. The authors came to the same conclusion as that of Pitman et al [19], namely that a heterogeneous vaccination program stretching across both groups would be the optimal policy, with all three pediatric vaccination strategies investigated (heterogeneous, secondary, and primary schools) being cost-effective.…”

“…The question as to whether extension of influenza vaccination from conventional target groups (elderly and other traditional risk groups) to children is cost-effective has been analyzed by Pitman et al for England and Wales, using a dynamic model [19]. The authors used a previously published extended SIR model [4], and, for the age-dependent contact patterns, the results of the POLYMOD (Improving Public Health Policy in Europe through Modelling and Economic Evaluation of Interventions for the Control of Infectious Diseases) study were used [10].…”

Live attenuated influenza vaccine for children

“…32 Another study suggested that paediatric vaccination could be more cost-effective in reducing influenza in older people than direct vaccination of older people not in clinical risk groups. 33 …”