Seasonal influenza in children: Costs for the health system and society in Europe

Abstract

Background Pediatric influenza causes significant morbidity annually, resulting in an increased economic burden. Therefore, we aimed to summarize existing literature regarding the costs of pediatric influenza in Europe, paying particular attention to the direct and indirect costs considered in the economic evaluations. Knowing health and social costs of childhood influenza is essential to support value‐based health decisions to implement effective immunization strategies. Methods We searched three databases for articles published to September 3, 2021. Eligible studies were those reporting the economic burden of influenza in the pediatric and youth population in European countries written in English language. Results Overall, 2225 records were screened, and 9 articles were included. Costs estimates are different across countries and in the age groups considered. Direct costs per episode, whose major expense driver are hospitalizations and pediatric examinations, range from about €74 in Italy to €252 in Germany. Important variations are observed based on age, with the youngest group absorbing in some cases double the resources of the older ones such as (in Italy, in France and in Germany). Regarding indirect costs, workdays lost by parents resulted in higher costs for children <2 years and 2–5 years than those >5 years of age and their economic impact was variable reaching €251 per week in Germany. Conclusion Evidence obtained in our review strengthened the awareness about the economic impact, in terms of direct and indirect costs, of pediatric influenza requiring, as a priority action in Europe, the implementation of influenza vaccination policies in this target population.

Influenza Vaccination Assessment according to a Value-Based Health Care Approach

“…Of the 40 studies included in our systematic review [ 3 , 4 , 5 , 8 , 10 , 11 , 12 , 13 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ], seven (17.5%) had a non-European perspective and were conducted in Canada ( n = 1) [ 18 ], the USA ( n = 3) [ 19 , 21 , 42 ], China ( n = 1) [ 36 ], Iran ( n = 1) [ 49 ], and low-income countries (LICs) ( n = 1) [ 32 ]; ten (25%) had a global perspective [ 5 , 10 , 12 , 20 , 22 , 24 …”

“…Among the European studies, eight (36.4%) were conducted specifically in Italy [ 3 , 4 , 13 , 31 , 38 , 39 , 43 , 47 ]. In addition, of the 40 articles included in our work, 17 (42.5%) were systematic reviews or literature reviews [ 3 , 5 , 10 , 11 , 12 , 22 , 24 , 25 , 28 , 29 , 30 , 31 , 32 , 37 , 41 , 47 , 48 ], ten (25%) were economic evaluations [ 8 , 13 , 19 , 21 , 23 , 26 , 27 , 34 , 44 , 45 ], seven (17.5%) were cross-sectional studies [ 18 , 35 , 36 , 38 , 42 , 43 , 49 ], two studies (5%) were HTA reports [ 4 , 39 ], one study (2.5%) was a nonlinear regression model [ 33 ], and three studies (7.5%) were expert opinions [ 20 , 40 , 46 ]. The main features of the studies are shown in Table 1 .…”

“…Regarding the influenza vaccination target population investigated in the studies included in our systematic review, 11 studies (27.5%) focused on vaccination in the general population [ 5 , 12 , 18 , 20 , 25 , 37 , 39 , 40 , 44 , 46 , 48 ], five (12.5%) on vaccination in the pediatric population [ 3 , 19 , 29 , 33 , 45 ], three (7.5%) on vaccination in the population aged 6 months to over 85 [ 21 , 27 , 28 ], seven (17.5%) on vaccination in elderly individuals (over 65) [ 4 , 11 , 24 , 30 , 31 , 41 , 47 ], two (5%) specifically on adults over 18 [ 38 ] and over 50 [ 26 ], one study (2.5%) specifically on influenza vaccination in elderly individuals and at risk groups [ 22 ], one (2.5%) on the target population for which the WHO recommends flu vaccination [ 8 ], one (2.5%) on customs officers [ 23 ], four (10%) on HCWs [ 10 , 34 , 35 , 36 ], one (2.5%) on workers in general [ 13 ], two (5%) on health care students [ 42 , 43 ], one (2.5%) on pregnant women [ 32 ], and another study (2.5%) on influenza vaccination in the cancer population [ 49 ].…”

“…In particular, seasonal influenza epidemics cause approximately 3–5 million severe cases annually, especially among vulnerable groups, such as elderly individuals, younger children (<5 years of age), pregnant women, and individuals with chronic diseases, and 290,000 to 650,000 deaths globally [ 2 ]. Vaccination is the key to preventing influenza and its consequences and to reducing its clinical and economic burden on health care systems and society [ 3 ].…”

“…To date, even the flu vaccination has not been evaluated to fully account for all its benefits. However, influenza vaccination has a substantial whole value, as it has personal value because it guarantees protection to individuals [ 8 ]; it has considerable societal value because the vaccination of the individual or of some groups at risk, such as children and health care workers (HCWs), protects the most vulnerable people, such as elderly individuals [ 9 , 10 , 11 ]; influenza vaccination is cost-effective [ 12 ]; it can also reduce indirect costs related to the loss of productivity of workers and caregivers [ 3 ]; and it has an important fiscal impact, as guaranteeing the health of workers increases the tax revenues of the state and the propensity to consume of workers and their families [ 13 ].…”