Cost effectiveness of vaccination against pandemic influenza in European countries: mathematical modelling analysis

Abstract

Objective To investigate whether a single optimal vaccination strategy exists across countries to deal with a future influenza pandemic by comparing the cost effectiveness of different strategies in various pandemic scenarios for three European countries.Design Economic and epidemic modelling study.Settings General populations in Germany, the Netherlands, and the United Kingdom.Data sources Country specific patterns of social contact and demographic data.Model An age structured susceptible-exposed-infected-recovered transmission model that describes how an influenza A virus will spread in the populations of Germany, the Netherlands, and the United Kingdom.Interventions Comparison of four vaccination strategies: no vaccination, blanket vaccination, vaccination of elderly people (≥65 years), and vaccination of high transmitters (5-19 years). The four strategies were evaluated for scenarios in which a vaccine became available early or at the peak of the pandemic, and in which either everyone was initially susceptible or older age groups had pre-existing immunity.Main outcome measure Cost per quality adjusted life years (QALYs) gained.Results All vaccination strategies were cost effective (incremental cost per QALY gained, comparing intervention with non-intervention). In scenarios where the vaccine became available at the peak of the pandemic and there was pre-existing immunity among elderly people the incremental cost effectiveness ratios for vaccinating high transmitters were €7325 (£5815; $10 470) per QALY gained for Germany, €10 216 per QALY gained for the Netherlands, and €7280 per QALY gained for the United Kingdom. The most cost effective strategy not only differed across the pandemic scenarios but also between countries. Specifically, when the vaccine was available early in the pandemic and there was no pre-existing immunity, in Germany it would be most cost effective to vaccinate elderly people ( €940 per QALY gained), whereas it would be most cost effective to vaccinate high transmitters in both the Netherlands (€525 per QALY gained) and the United Kingdom (€163 per QALY gained). This difference in optimal strategies was due to differences in the demographic characteristics of the countries: Germany has a significantly higher proportion of elderly people compared with the Netherlands and the United Kingdom.Conclusions No single vaccination strategy was most cost effective across countries. With aging populations, pre-existing immunity in particular could be of crucial importance for the cost effectiveness of options to mitigate a future influenza pandemic.

Modelling during an emergency: the 2009 H1N1 influenza pandemic

“…For example, a study by Lugner et al . ranged vaccination coverage from 45% to 90% vs. 20–100% for a study by Lee et al . .…”

Systematic Review of Economic Evaluations of Preparedness Strategies and Interventions against Influenza Pandemics

“…There were 98 records that met the inclusion criteria and were assessed for eligibility, while 56 full texts were not included in the final analysis. These studies were excluded because they were reviews (14), were not economic evaluations (9), focused on seasonal influenza (6), focused on the impact of influenza (7), had no full text available for some conference abstracts (9), were not in the eligible languages (1), or did not report both the costs and outcomes of interventions (10). In addition, eight full text papers were identified from correspondence with authors of eligible papers, cited reference searching, and reference list screening, of which six were excluded as they studied the impact of disease (2) or were not economic evaluations (4).…”

“…NOriginal economic evaluations considering prevention or control of the 2009 human influenza pandemic or other potential human influenza pandemics NPartial economic evaluations if both costs and outcomes of one intervention, either pharmaceutical or non-pharmaceutical, were considered NFull economic evaluations if costs and outcomes of more than one pharmaceutical or non-pharmaceutical interventions were considered multinational settings, for example, one was conducted for three European countries [9] while another covered up to ten countries in diverse income groups. [10] The characteristics of the studies included in the analysis are summarized in Table S4.…”

“…In this regard, we reviewed the relevant sources and found that the quality of evidence used ranges from assumption [51] to data from a large study conducted in the European Union. [9,12,39,48,49] Only one study conducted after the 2009 H1N1 pandemic appears to employ real data in areas affected by the pandemic to construct a social network. [24] In general, all epidemic models have an underlying network of mixing patterns, even though this network may not be explicit.…”

Global stability analysis for a generalized delayed SIR model with vaccination and treatment

“…A fraction ∈ [0.1) (the all-or-nothing parameter) of the vaccinated newborns exhibits an unsuccessful vaccination and passes directly to the susceptible class. Our vaccine has an efficacy of 1 -(see [27][28][29][30][31][32][33]). For simplicity, we assume that the recovered class stands also for the vaccinated state.…”