Public Health and Economic Benefits of Influenza Vaccination of the Population Aged 50 to 59 Years without Risk Factors for Influenza Complications in Mexico: A Cross-Sectional Epidemiological Study.

Miguel Betancourt-Cravioto,Jorge Abelardo Falcón-Lezama,Myrna María Alfaro-Cortés,Rodrigo Saucedo-Martínez,Roberto Tapia-Conyer

doi:10.3390/vaccines9030188

Abstract

The Mexican influenza vaccination program does not include a recommendation for people aged 50–59 years without risk factors for influenza complications, and there are limited data regarding the cost-effectiveness of vaccinating this population. To explore the clinical and economic effects of including this population in the vaccination schedule, we performed a cross-sectional epidemiological study using records (2009–2018) from Mexico’s Influenza Surveillance System (SISVEFLU), death records (2010–2015) from the National Mortality Epidemiological and Statistical System, and discharge and hospitalization records (2010–2015) from the Automated Hospital Discharge System databases. A 1-year decision-analytic model was used to assess cost-effectiveness through a decision-tree based on data from SISVEFLU. The primary outcome was influenza cases avoided; with associated influenza-related events as secondary outcomes. Including the population aged 50–59 years without risk factors in Mexico’s influenza immunization program would have resulted in 199,500 fewer cases; 67,008 fewer outpatient consultations; 33,024 fewer emergency room consultations; 33,091 fewer hospitalizations; 12 fewer deaths. These reductions equate to a substantial public health benefit as well as an economic benefit; yielding net savings of 49.8 million US dollars over a typical influenza season. Expansion of the current Mexican vaccination schedule to include these people would be a cost-saving and dominant strategy.

Highlights

Every year, influenza affects millions of people of all age groups, which has substantial public health and economic impacts [1]
For patients admitted via an outpatient clinic who were referred for hospitalization that resulted in death, we considered the average hospital stay (8.3 days) for patients aged 50 to 59 years with influenza, according to SAEH [24]
To estimate direct medical costs, we considered public unit costs of each of the institutions that comprise the Mexican Health System, and weighted them by the proportion of the population affiliated in each institution for the influenza seasons from 2009–2010 to

Summary

Introduction

Influenza affects millions of people of all age groups, which has substantial public health and economic impacts [1]. In Latin America, the annual incidence of influenza-like illness (ILI) ranges between 4.7% and 15.4% [3]. Safe and effective influenza vaccines have been available for more than years [4,5,6], the constant genetic shifts and drifts of the virus remain the most relevant challenge for disease control. Implementation of influenza immunization campaigns throughout the world have led to decreases in both mortality and morbidity [7,8]. Vaccination in most age groups, including adults, is considered highly cost-effective [9,10]

Methods

Results

Discussion

Conclusion