Abstract
SummaryBackgroundIn 2013 England and Wales began to fund a live attenuated influenza vaccine programme for individuals aged 2–16 years. Mathematical modelling predicts substantial beneficial herd effects for the entire population as a result of reduced influenza transmission. With a decreased influenza-associated disease burden, existing immunisation programmes might be less cost-effective. The aim of this study was to assess the epidemiological effect and cost-effectiveness of the existing elderly and risk group vaccination programme under the new policy of mass paediatric vaccination in England.MethodsFor this cost-effectiveness analysis, we used a transmission model of seasonal influenza calibrated to 14 seasons of weekly consultation and virology data in England and Wales. We combined this model with an economic evaluation to calculate the incremental cost-effectiveness ratios, measured in cost per quality-adjusted life-years (QALY) gained.FindingsOur results suggest that well timed administration of paediatric vaccination would reduce the number of low-risk elderly influenza cases to a greater extent than would vaccination of the low-risk elderly themselves if the elderly uptake is achieved more slowly. Although high-risk vaccination remains cost-effective, substantial uncertainty exists as to whether low-risk elderly vaccination remains cost-effective, driven by the choice of cost-effectiveness threshold. Under base case assumptions and a cost-effectiveness threshold of £15 000 per QALY, the low-risk elderly seasonal vaccination programme will cease to be cost-effective with a mean incremental cost-effectiveness ratio of £22 000 per QALY and a probability of cost-effectiveness of 20%. However, under a £30 000 per QALY threshold, the programme will remain cost-effective with 83% probability.InterpretationWith the likely move to decreased cost-effectiveness thresholds, reassessment of existing risk group-based vaccine programme cost-effectiveness in the presence of the paediatric vaccination programme is needed.FundingNational Institute for Health Research, the Medical Research Council.
Highlights
For this cost-effectiveness analysis, we used a transmission model of seasonal influenza calibrated to 14 seasons of weekly consultation and virology data in England and Wales. We combined this model with an economic evaluation to calculate the incremental cost-effectiveness ratios, measured in cost per quality-adjusted life-years (QALY) gained
This study showed paediatric vaccination to be very cost-effective, the study only superficially assessed the effect of this programme on existing target group vaccination
Our study suggests that a mass paediatric vaccination programme will not affect the existing recommendation of risk group vaccination in England
Summary
Individuals at high risk of serious complication after an influenza infection have historically been the target for seasonal influenza annual vaccination programmes worldwide.[1,2,3] because of the indirect effects of vaccination, termed herd protection, the vaccination of groups who are important for transmission of infection is often cost-effective.[4,5] A large proportion of this transmission is attributable to children and adolescents because of the relatively high number of contacts they have with others,[6,7,8] the fraction of these contacts that involve touching,[6,7,8] and their susceptibility to influenza infection.[9,10] Some countries have broadened their seasonal influenza vaccine recommendations to immunise healthy children and adolescents every year, for example in the USA11 and more recently in the UK in 2012.12,13If paediatric immunisation programmes gain high coverage early enough in the influenza season to interrupt transmission to risk groups, any existing risk group-based vaccine programme becomes less cost-effective. Individuals at high risk of serious complication after an influenza infection have historically been the target for seasonal influenza annual vaccination programmes worldwide.[1,2,3] because of the indirect effects of vaccination, termed herd protection, the vaccination of groups who are important for transmission of infection is often cost-effective.[4,5] A large proportion of this transmission is attributable to children and adolescents because of the relatively high number of contacts they have with others,[6,7,8] the fraction of these contacts that involve touching,[6,7,8] and their susceptibility to influenza infection.[9,10] Some countries have broadened their seasonal influenza vaccine recommendations to immunise healthy children and adolescents every year, for example in the USA11 and more recently in the UK in 2012.12,13. If a national paediatric programme renders elderly and risk group vaccination programmes not cost-effective, removing annual vaccination from these target groups will allow a large annual saving. Previous analysis in the context of the UK suggests that substantial uncertainty exists regarding the cost-effectiveness of an elderly low-risk programme in the presence of a moderate vaccine uptake of 50% in healthy children[12,13] and adolescents, with a third of simulations finding the elderly vaccine not to be cost-effective
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