Economic Burden Of Influenza Research Articles

Cost effectiveness of quadrivalent influenza vaccines in the elderly population of Malaysia

The economic burden of influenza is a significant issue within healthcare system, related to higher medical costs particularly among the elderly. Yet, influenza vaccination rates in the elderly in Malaysia were considerably low as it is not part of Malaysia’s national immunization program, with substantial mortality and morbidity consequences. Therefore, we conducted a cost-effectiveness analysis of quadrivalent influenza vaccine (QIV) for the elderly in Malaysia compared with the current no-vaccination policy. A static cost-utility model, with a lifetime horizon based on age, was used for the analysis to assess the cost-effectiveness and health outcomes associated with QIV. Univariate and probabilistic sensitivity analyses were performed to test the effects of variations in the parameters. The use of QIV in Malaysia’s elderly population would prevent 66,326 potential influenza cases and 888 potential deaths among the elderly, leading to 10,048 potential quality-adjusted life years (QALYs) gained. The QIV would also save over USD 4.4 million currently spent on influenza-related hospitalizations and reduce productivity losses by approximately USD 21.6 million. The ICER per QALY gained from a third-party payer’s perspective would be USD 2216, which is lower than the country’s gross domestic product per capita. A QIV-based vaccination program in the elderly was found to be highly cost-effective, therefore would reduce the financial burden of managing influenza and reduce pre-mature death related to this disease.

The economic burden of influenza among adults aged 18 to 64: A systematic literature review.

While the economic burden of influenza infection is well described among adults aged 65 and older, less is known about younger adults. A systematic literature review was conducted to describe the economic burden of seasonal influenza in adults aged 18 to 64 years, to identify the main determinants of direct and indirect costs, and to highlight any gaps in the existing published evidence. MEDLINE and Embase were searched from 2007 to February 7, 2020, for studies reporting primary influenza‐related cost data (direct or indirect) or absenteeism data. Of the 2613 publications screened, 51 studies were included in this review. Half of them were conducted in the United States, and 71% of them described patients with influenza‐like illness rather than laboratory‐confirmed disease. Only 12 studies reported cost data specifically for at‐risk populations. Extracted data highlighted that within the 18‐ to 64‐year‐old group, up to 88% of the economic burden of influenza was attributable to indirect costs, and up to 75% of overall direct costs were attributable to hospitalizations. Furthermore, within the 18‐ to 64‐year‐old group, influenza‐related costs increased with age and underlying medical conditions. The reported cost of influenza‐related hospitalizations was found to be up to 2.5 times higher among at‐risk populations compared with not‐at‐risk populations. This review documents the considerable economic impact of influenza among adults aged 18 to 64. In this age group, most of the influenza costs are indirect, which are generally not recognized by decision makers. Future studies should focus on at‐risk subgroups, lab‐confirmed cases, and European countries.

Cost-effectiveness of high dose versus adjuvanted trivalent influenza vaccines in England and Wales

Aims High dose trivalent influenza vaccine (HD TIV) and adjuvant TIV (aTIV) have been developed specifically for adults aged 65 and older (65+) who are at high risk of life-threatening complications. However, there is a scarcity of evidence comparing the clinical and cost-effectiveness of HD TIV and aTIV. The aim of this study was to determine the cost-effectiveness of HD TIV versus aTIV in the England and Wales 65+ population. Methods A cost-utility analysis was conducted using a decision tree with two influenza related outcomes: Laboratory confirmed cases that could result in GP consultation, and hospitalizations that may result in premature mortality. Due to a lack of comparative evidence, the effectiveness of HD TIV versus aTIV was calculated indirectly, based on relative effectiveness estimates for each vaccine versus a common comparator, standard dose (SD) TIV. The primary analysis included hospitalizations explicitly due to influenza/pneumonia. Cost-effectiveness was established for three scenarios applying differing relative effectiveness estimates for aTIV versus SD TIV. Uncertainty was analysed in one-way deterministic sensitivity analyses. A secondary analysis included hospitalizations due to any respiratory illness. Results The minimum population impact of vaccination with HD TIV rather than aTIV was 13,092 fewer influenza cases, 1,109 fewer influenza related deaths, 4,673 fewer hospitalizations, and 3,245 fewer GP appointments. HD TIV was cost-effective versus aTIV for all three effectiveness scenarios, with incremental cost-effectiveness ratios (ICER) equal to £1,932, £4,181, and £8,767 per quality adjusted life year. Results were consistent across the secondary analysis and deterministic sensitivity analyses. Limitations The analysis was limited by a lack of robust and consistent effectiveness data for aTIV. Conclusion HD TIV is cost-effective versus aTIV in people aged 65+ in England and Wales. Use of HD TIV over aTIV could increase clinical benefits and reduce the public health and economic burden of influenza.

Parental Attitude to Influenza Infection: Willingness for Childhood Vaccination

Introduction: As the 2020- 2021 flu season coincides with the currently circulating Coronavirus disease 2019 (COVID-19), Ireland is introducing free influenza vaccines to children ages 2- 12 this year. This is to minimise the disease and economic burden of influenza to an already- strained hospital system due to the ongoing pandemic. Therefore, it is important to identify factors that may affect vaccine uptake. Objective: To explore parental knowledge and attitudes towards influenza infection and potential factors affecting willingness to routinely vaccinate their child (ren). Methods: This descriptive study involved interviewing parents (n= 300) attending the paediatric outpatient department (OPD) at University Hospital Galway. A pilot study assisted with standardizing the questionnaire and in optimizing the clinical catchment area (Emergency Department vs. postnatal ward vs. OPD clinics). Galway Clinical Research Ethics Committee granted the ethical approval and data was analyzed using SPSS. Results: The majority of respondents were Irish (251, 83.7%), 236 (78.7%) with private health insurance. The commonest age range was 31-40 years (163, 54.3%). Less than 40% had a Bachelor’s degree (113, 37.7%) as their highest education level. Most participants (226, 75.3%) agreed with annual influenza vaccine for their child if recommended. The following factors were shown to positively affect potential annual influenza vaccine uptake (p

PIN72 Burden of Influenza-Related and Associated Hospitalizations in France from Season 2010/11 to 2017/18

Each season in France, influenza infection is responsible for an important outbreak conducting to 2-6 million GP visits and leading to several thousands of deaths. Although influenza epidemic is closely monitored by the French national public health agency (Santé publique France), the hospital burden of influenza is still underappreciated. The study objective is to describe the public health and economic burden of influenza at hospital from the season 2010/11 to 2017/18. Data on influenza-associated hospitalizations were extracted from the French national hospital administrative database (PMSI). The number of hospital stays and the corresponding number of hospitalized patients were determined using disease-specific ICD-10 codes (J09/J10/J11) used as main and associated diagnostic. Associated costs were estimated from the payer’s perspective, using French official tariffs. Over the period, 18,979 [min: 8,627; max: 44,024] influenza hospitalizations occurred on average per season. Age distribution of hospitalized patients varied from one season to another: patients aged ≥65 years accounted for 14% of the stays in 2010/11 versus 66% in 2016/17 and 52% in 2017/18. Mean length of stay was 8.3 days, [min: 3 days; max: 10 days] with oldest patients experiencing the longest stays. On average, influenza stays cost 81,9M€ per season [min: 26,4M€; max: 209,7M€]. The mean cost of hospitalization was 4,319€ [min: 1,206€; max: 5,118€]. Influenza is associated with a substantial number of hospitalizations and massive costs each season. Our estimate is expected to be conservative. Additional studies including burden associated with influenza-related and associated complications are needed to have a comprehensive estimate of the burden of influenza at hospital.

Ranking dynamics of economic burden of infectious diseases as a criterion of effectiveness of epidemiologic control

Purpose: rank-based assessment of the economic impact of infectious diseases in the Russian Federation for the further analysis of effectiveness of their prevention and for prioritization of preventive measures.Materials and Methods. The annual economic burden was eStimated by using inflation-adjusted standard economic costs of one case of infectious disease in the Russian Federation. The data on the number of cases were obtained from the official statistical reports (Forms 1, 2) for 2009-2019. The annual burden of the specific disease was estimated by multiplying the standard cost of 1 case by the number of cases registered within a given year. The economic costs were assessed and ranked.Results and discussion. In 2019, the greatest economic burden was exerted by acute respiratory infections, tuberculosis, acute gastrointestinal infections, chickenpox, HIV infection (newly diagnosed cases and deaths in 2019). The economic burden of rotavirus infection was assessed and ranked for the first time. The ranking analysis of the economic costs in 2009-2019 showed the largest decrease in the economic burden of influenza, rubella, acute and chronic hepatitis B. At the same time, the economic burden of measles, pertussis, hemorrhagic fevers and tick-borne borreliosis demonstrated an upward trend. The possibility of using ranking dynamics of economic burden as a performance indicator of epidemiological control has been demonstrated. In response to limited public funding of healthcare, the offered method can be used in setting priorities in decision making in the field of epidemic control.

PIN116 THE BURDEN OF INFLUENZA POSITIVE INPATIENTS IN TURKEY

Respiratory viral infections, primarily influenza, can be one of the most important reasons of hospitalization, resource utilization and spendings during the influenza season. We aimed to demonstrate the expenditures of inpatients who were diagnosed to have influenza in a cohort of hospitalized patients. Patients hospitalized in internal medicine wards and who had nasal swab sampling for a suspected viral infection were included between 1 August 2018 to 31 March 2019. Patients were followed until discharge or exitus. Hospital spendings were retrieved from the Hospital Information Management System. Data of 254 patients with 262 hospitalization episodes were analyzed, 125 patients (47,7%) were infected with at least one viral pathogen. Median age was 63,7 years and length of stay was 17 days (5-160 days). 53,1% of the patients were admitted from the emergency room. The total hospital spending of the inpatients was 4,168,094 TRY. Half of this expenditure was pharmaceutical expenditure (2,023,071 TRY). Mean expenditure per patient was 16,410 TRY. Twenty-one percent of the patients were diagnosed to have influenza, median length of stay was 15 days (5-160 days), mortality was 10,9% and their total expenditure was 966.984 TRY (17.581 TRY per patient). Influenza is an important cause of hospitalization and severe illness, and it results in substantial economic burden, due to both medical care costs and productivity loss. There is lack of data about the economic burden of influenza in Turkey. We showed that the expenditure per patient was higher for patients infected with influenza. Pharmaceutical expenditures constituted the major group of spending in accordance with other studies.

Epidemiology and cost of seasonal influenza in Germany - a claims data analysis

BackgroundSeasonal influenza contributes substantially to the burden of communicable diseases in Europe, especially among paediatric populations and the elderly. The aim of the present study was to estimate the incidence of seasonal influenza in Germany, the probabilities of related complications and the economic burden of influenza per case and on a population level for different age groups.MethodsClaims data from 2012 to 2014 from > 8 million insured of a large German sick-ness fund were analysed. A matched case control study was used on a sub-sample of 100,000 influenza cases to calculate complication rates for ear infections/acute otitis media (AOM) and community-acquired pneumonia (CAP) as well as resource use and costs for seven age groups.ResultsIncidence of seasonal influenza varies between the years and is highest among infants and children 2 to 5 years of age. AOM is more likely in the younger age groups with up to 14% more patients in the influenza group than in the control group. CAP is more frequently observed in the younger age groups and in influenza patients 60 years and older. The manifestation of one influenza complication (AOM or CAP) significantly in-creases the occurrence of a second complication (AOM or CAP). The economic burden per case is highest in infants (€251.91) and persons over 60 years of age (€131.59).ConclusionThe burden of influenza is highest among infants and young children, which is also reflected in the economic burden. Influenza related costs per case are nearly double for infants compared to persons over 60 years of age.

Padlock Probe Assay for Detection and Subtyping of Seasonal Influenza.

Influenza remains a constant threat worldwide, and WHO estimates that it affects 5% to 15% of the global population each season, with an associated 3 to 5 million severe cases and up to 500000 deaths. To limit the morbidity and the economic burden of influenza, improved diagnostic assays are needed. We developed a multiplexed assay for the detection and subtyping of seasonal influenza based on padlock probes and rolling circle amplification. The assay simultaneously targets all 8 genome segments of the 4 circulating influenza variants-A(H1N1), A(H3N2), B/Yamagata, and B/Victoria-and was combined with a prototype cartridge for inexpensive digital quantification. Characterized virus isolates and patient nasopharyngeal swabs were used for assay design and analytical validation. The diagnostic performance was assessed by blinded testing of 50 clinical samples analyzed in parallel with a commercial influenza assay, Simplexa™ Flu A/B & RSV Direct. The assay had a detection limit of 18 viral RNA copies and achieved 100% analytical and clinical specificity for differential detection and subtyping of seasonal circulating influenza variants. The diagnostic sensitivity on the 50 clinical samples was 77.5% for detecting influenza and up to 73% for subtyping seasonal variants. We have presented a proof-of-concept padlock probe assay combined with an inexpensive digital readout for the detection and subtyping of seasonal influenza strains A and B. The demonstrated high specificity and multiplexing capability, together with the digital quantification, established the assay as a promising diagnostic tool for seasonal influenza.

Use of modeling in the study of economic burden of influenza in the elderly population in Central and Eastern European countries

The economic burden of the incidence of influenza and ARI requires careful study, since annually about 15% of the world's population suffers from these diseases. In addition, the flu can cause complications that are dangerous to human life and health, especially those at risk. The elderly population belongs precisely to this group, therefore we have chosen to analyze the economic burden of this category of population. According to the international classification, this group of diseases is divided into the following types:
 
 Influenza-like illness (ILI);
 
 – Acute respiratory infection (ARI);
 – Severe acute respiratory infections (SARI);
 – Severe Acute Respiratory Syndrome (SARS).
 The aim of the work was to develop a model for systematization flows of patients and treatment costs in assessing the economic burden of influenza and ARI morbidity in the elderly peoples in Central and Eastern Europe. The model was developed in cooperation with the Syreon Institute, Hungary. The study involved Hungary, Poland, the Czech Republic, Romania, Ukraine and Kazakhstan.
 The structure of the model is based on the assumption of a flow of patients. The principle of the model was as follows: in order to assess the economic burden of the disease in a certain period of time, it is necessary to quantify (1) the number of patients, and (2) the costs of health care and treatment. The cost of treatment is different in each case, patients should be divided into relatively homogeneous groups. Since the quantity and quality of the epidemiological data on influenza and related diseases is rather heterogeneous in different countries, WHO offers certain objects of influenza research, taken as a basis for constructing such a model. According to this classification of influenza and WHO definition, the central structure of our model was formed by acute respiratory infections (ARI), representing outpatient cases and severe acute respiratory infections (SARI), representing inpatient cases.
 The next stage of the research was the study of the cost structure and the principles of collecting expenditure data. The economic burden of influenza in the elderly populations has been analyzed based on the type of health system. In older people, it is difficult to establish a link between influenza and complications of chronic diseases and other acute medical conditions (eg, acute coronary syndrome). This analysis does not include estimates of the economic impact of influenza on other co-morbidities and long-term chronic effects associated with complications of influenza. Since the population of 60+ or 65+ is a risk group and is a numerical group, the cost of treatment in the event of complications and hospitalization will increase cost for the patient and for the medical institution. However, in this case indirect costs is missing, such as paying a sick list. Direct medical cost were subject to analysis. The proposed methodology allows you to objectively assess the costs of treatment and calculate the economic burden, taking into account the type and health system.

Increasing influenza and pneumococcal vaccine uptake in the elderly: study protocol for the multi-methods prospective intervention study Vaccination60+

BackgroundInfluenza and pneumococcal vaccination can prevent disease and potentially life-threatening complications like sepsis. Elderly people have an increased risk of severe disease and therefore constitute a major target group for vaccination. To increase vaccination coverage, targeted interventions are needed that take theory-based specific determinants of vaccination behaviour into account. Moreover, message and campaign design should consider specific age-related characteristics (e.g., information processing, media use). The aim of this study is (i) to identify the specific informational and interventional needs of this risk group, (ii) to design and implement a targeted intervention aiming to decrease vaccine hesitancy, increase vaccine uptake and decrease the health and economic burden due to the respective diseases, and (iii) to measure the effect of this evidence-informed intervention on various levels.MethodsProspective, multi-methods intervention study targeting individuals aged ≥60 years in a model region in Germany (federal state of Thuringia, 500,000 inhabitants ≥60 years old). The development of the intervention follows theory-based and evidence-informed principles: Data from a cross-sectional representative study provide insights into specific determinants of the target group’s vaccination behaviour. Additionally, media use is analysed to identify adequate communication channels for specific subgroups.In pilot studies, the intervention materials are adapted to the specific cognitive requirements of the target group. For development and implementation of the intervention, an interdisciplinary and trans-sectoral approach is used, including psychology, communication science, design, medical science, epidemiology and various public health players. The intervention will be implemented in autumn and winter 2017/18 and 2018/19 and adjusted in between. Evaluation of the intervention includes: awareness, use and recall of intervention materials, effects on changes in determinants of vaccination behaviour, self-reported vaccine uptake, and vaccination coverage in the intervention area (primary outcomes), as well as disease incidences (secondary outcomes) and the economic burden of influenza, pneumonia, invasive pneumococcal disease and sepsis for the healthcare system (tertiary outcomes).DiscussionThe data will add to the body of evidence on the effectiveness of evidence-informed vaccination campaign development as well as on the clinical and economic effects of pneumococcal and influenza vaccination. The effect of the intervention will teach valuable lessons about the principles of campaign development and evaluation, and can motivate a subsequent nationwide intervention.Trial registrationDRKS00012653. Registered 24.11.2017. Retrospectively registered.

Clinical characteristics and economic burden of influenza among children under 5 years old, in Suzhou, 2011-2017

Objective: To understand the clinical characteristics and economic burden of influenza-like illness (ILI) children aged 0-59 months in the outpatient settings in Suzhou, China, 2011-2017. Methods: From March 2011 to February 2017, we conducted a prospective surveillance program on ILI for children aged less than 5 years at Soochow University Affiliated Children's Hospital. Through standard questionnaires and follow-up survey via telephone, we collected information regarding the demographic characteristics, medical history, clinical symptoms and both direct and indirect costs associated with influenza, of the patients. We then compared clinical characteristics and economic burden of influenza A/H1N1, A/H3N2, and B infections among children with ILI. Results: We enrolled 6 310 patients with ILI from March 2011 to February 2017 and collected all their throat swabs. 791 (12.9%) of the swabs showed positive for influenza virus, including 88 (11.1%) subtype influenza A/H1N1, 288 (36.4%) subtype influenza A/H3N2, and 415(52.5%) type influenza B. The proportions of cough, rhinorrhea, wheezing, vomiting and convulsion in influenza-positive children were higher than those influenza-negative children. Except for the prevalence rates of cough (χ(2)=9.227, P=0.010), wheezing (χ(2)=7.273, P=0.026) and vomiting (χ(2)=8.163, P=0.017), other clinical symptoms appeared similar between the three viral subtypes. Among all the ILI children, the average total cost per episode of influenza was 688.4 Yuan (95%CI: 630.1-746.7) for influenza-negative children; 768.0 Yuan (95%CI: 686.8-849.3) for influenza-positive children and 738.3 Yuan (95%CI: 655.5-821.1) for influenza B. Children with influenza A/H1N1 spent much more than those with influenza A/H3N2 or influenza B in the total cost (χ(2)=7.237, P=0.028). Conclusion: Children infected influenza showed higher prevalence rates of cough, rhinorrhea, wheezing, vomiting and convulsion than those without influenza. Influenza A/H1N1 subtype caused heavier economic burden than the other two influenza subtypes.

PIN17 - Global Burden of Seasonal Influenza Disease: A Structured Literature Review

To review published data on the global burden of seasonal influenza in terms of epidemiology, economics, and impact on health-related quality of life (HRQoL). The overall incidence of seasonal influenza was estimated from the incidence rates of infected cases in the placebo groups of clinical trials on vaccines and prophylactic antivirals identified in systematic literature reviews. Targeted searches were performed on Medline to assess: the overall economic burden of influenza from observational studies, HRQoL associated with influenza and excess mortality/hospitalization rates during influenza outbreaks based on statistical regression analyses. Geographical scope covered the US, EU5 and Japan. Average incidence of laboratory-confirmed influenza was estimated between 3.71% in adults and 35.39% in children over 6 and up to 16 years old (yo). Large variability, related to different factors including season, country and target population, was observed between studies. The incidence rate of hospitalization appeared relatively high in <5 yo children, declined in 5-17 yo children and increased progressively after 18 yo. Patients aged >65 yo had the highest mortality rates. Type A influenza caused more hospitalizations and deaths than type B. Influenza resulted in a significant economic burden, including office visits, laboratory tests, emergency department visits, hospital stays with possible ICU admission, and medications. Major cost components were the productivity costs (absenteeism of infected adults or parents of infected children), the physician visit costs and the hospitalization costs related to influenza or its complications. Although the HRQoL impact of influenza on the infected population is often highlighted in evaluations of influenza vaccines and treatments, data on the HRQoL impact of influenza are scarce. Despite efforts to vaccinate high-risk individuals, influenza remains associated with a substantial public health and economic burden in developed countries, mostly related to complications in high-risk patients, and absenteeism in otherwise healthy patients.

Influenza vaccination of elderly: relaunch time.

Influenza can be a serious disease and constitutes a threat to the population. Every year, seasonal influenza epidemics affect about 5-15% of the world's population. Some frail categories (such as the elderly) can develop complications, request hospitalization, and may die. In order to reduce the medical, social and economic burden of influenza, vaccination is recommended by many health authorities worldwide. Italy has a national programme ofinfluenzavaccination which targets specific categories, such as subjects with chronic conditions, pregnant women, healthcare workers and those over 65 years old. Despite this opportunity for prevention, however, vaccination coverage in Italy does not reach the minimum recommended threshold of 75%. This paper reports some interventions that can improve coverage rates of the elderly, such as "tailor-made" information campaigns, healthcare workers training and the adoption of innovative communication strategies in order to implement vaccination strategies that take into account the needs of the elderly population, the involvement of elderly people's associations in awareness-raising activities and strengthening the role of general practitioners in promoting influenza vaccination.

Rationale and opportunities in estimating the economic burden of seasonal influenza across countries using a standardized WHO tool and manual.

Influenza disease burden is recognized as one of the major public health problems globally. Much less is known about the economic burden of influenza especially in low‐ and middle‐income countries (LMICs). A recent systematic review on the economic burden of influenza in LMICs suggests that information is scarce and/or incomplete and that there is a lack of standardized approaches for cost evaluations in LMICs. WHO commissioned and publicized a Manual for estimating the economic burden of seasonal influenza to support the standardization of estimates of the economic burden of seasonal influenza across countries. This article aims to describe the rationale of this manual development and opportunities that lie in collecting data to help policymakers estimate the economic burden of seasonal influenza. It describes a manual developed by WHO to help such estimation and also links to relevant literature and tools to ensure robustness of applied methods to assess the economic burden associated with seasonal influenza, including direct medical costs, direct non‐medical costs and indirect costs.

Economic burden of influenza at a tertiary hospital in Vietnam

Economic burden of influenza at a tertiary hospital in Vietnam

Stimulating Influenza Vaccination via Prosocial Motives.

ObjectiveAmericans do not vaccinate nearly enough against Influenza (flu) infection, despite severe health and economic burden of influenza. Younger people are disproportionately responsible for transmission, but do not suffer severely from the flu. Thus, to achieve herd immunity, prosocial motivation needs to be a partial driver of vaccination decisions. Past research has not established the causal role of prosociality in flu vaccination, and the current research evaluates such causal relationship by experimentally eliciting prosociality through messages about flu victims.MethodsIn an experimental study, we described potential flu victims who would suffer from the decision of others to not vaccinate to 3952 Internet participants across eight countries. We measured sympathy, general prosociality, and vaccination intentions. The study included two identifiable victim conditions (one with an elderly victim and another with a young victim), an unidentified victim condition, and a no message condition.ResultsWe found that any of the three messages increased flu vaccination intentions. Moreover, this effect was mediated by enhanced prosocial motives, and was stronger among people who were historical non-vaccinators. In addition, younger victim elicited greater sympathy, and describing identifiable victims increased general sympathy and prosocial motives.ConclusionsThese findings provide direct experimental evidence on the causal role of prosocial motives in flu vaccination, by showing that people can be prompted to vaccinate for the sake of benefiting others.

Economic burden of seasonal influenza B in France during winter 2010-2011

BackgroundIn France, 2–15% of the population is affected annually by influenza, which causes significant socioeconomic disruption. Nevertheless, despite its importance for policy makers, few published studies have evaluated the impact of influenza B. Therefore, we assessed the costs associated with influenza B during 2010–2011 in France.MethodsCases of lab-confirmed influenza B were analyzed as part of the Influenza B in General Practice Study. Cost calculations were based on micro-costing methods according to the French Health Insurance (FHI) perspective (in Euros, 2011). Costs were compared between age groups using the Kruskal–Wallis test, and when significant, by multiple comparisons based on rank. Moreover, uncertainties were assessed using one-way sensitivity and probabilistic analyses. Overall economic burden was estimated by multiplying cost per patient, flu attack rate, and the French population.ResultsA total of 201 patients were included in the study. We found that the mean cost associated with Influenza B was 72€ (SD: 205) per patient: 70€ (SD: 262) for younger children, 50€ (SD: 195) for older children, 126€ (SD: 180) for adults, and 42€ (SD: 18) for elderly. Thus, we observed significantly different costs between the distinct age groups (p<0.0001). Finally, the economic burden of influenza B for the FHI was estimated to be 145 million Euros (95% CI: 88–201).ConclusionsOur findings highlight the important impact of influenza B and encourage further investigation on policy regarding vaccination strategies in France.

Medical and economic burden of influenza in the elderly population in central and eastern European countries

Influenza affects 5–15% of the population during an epidemic. In Western Europe, vaccination of at-risk groups forms the cornerstone of influenza prevention. However, vaccination coverage of the elderly (>65 y) is often low in Central and Eastern Europe (CEE); potentially because a paucity of country-specific data limits evidence-based policy making. Therefore the medical and economic burden of influenza were estimated in elderly populations in the Czech Republic, Hungary, Kazakhstan, Poland, Romania, and Ukraine. Data covering national influenza vaccination policies, surveillance and reporting, healthcare costs, populations, and epidemiology were obtained via literature review, open-access websites and databases, and interviews with experts. A simplified model of patient treatment flow incorporating cost, population, and incidence/prevalence data was used to calculate the influenza burden per country. In the elderly, influenza represented a large burden on the assessed healthcare systems, with yearly excess hospitalization rates of ~30/100 000. Burden varied between countries and was likely influenced by population size, surveillance system, healthcare provision, and vaccine coverage. The greatest burden was found in Poland, where direct costs were over EUR 5 million. Substantial differences in data availability and quality were identified, and to fully quantify the burden of influenza in CEE, influenza reporting systems should be standardized. This study most probably underestimates the real burden of influenza, however the public health problem is recognized worldwide, and will further increase with population aging. Extending influenza vaccination of the elderly may be a cost-effective way to reduce the burden of influenza in CEE.

Optimal strategies of social distancing and vaccination against seasonal influenza

Optimal control strategies for controlling seasonal influenza transmission in the US are of high interest, because of the significant epidemiological and economic burden of influenza. To evaluate optimal strategies of vaccination and social distancing, we used an age-structured dynamic model of seasonal influenza. We applied optimal control theory to identify the best way of reducing morbidity and mortality at a minimal cost. In combination with the Pontryagins maximum principle, we calculated time-dependent optimal policies of vaccination and social distancing to minimize the epidemiological and economic burden associated with seasonal influenza. We computed optimal age-specific intervention strategies and analyze them under various costs of interventions and disease transmissibility. Our results show that combined strategies have a stronger impact on the reduction of the final epidemic size. Our results also suggest that the optimal vaccination can be achieved by allocating most vaccines to preschool-age children (age under five) followed by young adults (age 20-39) and school age children (age 6-19). We find that the optimal vaccination rates for all age groups are highest at the beginning of the outbreak, requiring intense effort at the early phase of an epidemic. On the other hand, optimal social distancing of clinical cases tends to last the entire duration of an outbreak, and its intensity is relatively equal for all age groups. Furthermore, with higher transmissibility of the influenza virus (i.e. higher R0), the optimal control strategy needs to include more efforts to increase vaccination rates rather than efforts to encourage social distancing. Taken together, public health agencies need to consider both the transmissibility of the virus and ways to encourage early vaccination as well as voluntary social distancing of symptomatic cases in order to determine optimal intervention strategies against seasonal influenza.