期刊
VACCINE
卷 39, 期 2, 页码 447-456出版社
ELSEVIER SCI LTD
DOI: 10.1016/j.vaccine.2020.10.007
关键词
Seasonal influenza; Paediatric vaccination; Mathematical model; Cost-effectiveness analysis; Influenza; Children; Adolescents
The study evaluated the cost-effectiveness of prioritizing influenza vaccination to different age groups within the 2-16 year old age range to mitigate operational and resource challenges. Vaccinating Primary School children was found to be the most cost-efficient strategy, with a higher probability of cost-effectiveness at lower willingness-to-pay levels.
The current pediatric vaccination program in England and Wales administers Live-Attenuated Influenza Vaccine (LAIV) to children ages 2-16 years old. Annual administration of LAIV to this age group is costly and poses substantial logistical issues. This study aims to evaluate the cost-effectiveness of prioritizing vaccination to age groups within the 2-16 year old age range to mitigate the operational and resource challenges of the current strategy. We performed economic evaluations comparing the influenza vaccination program from 1995-2013 to seven alternative strategies targeted at low risk individuals along the school age divisions Preschool (2-4 years old), Primary school (5-11 years old), and Secondary school (12-16 years old). These extensions are evaluated incrementally on the status quo scenario (vaccinating subgroups at high risk of influenza-related complications and individuals 65+ years old). Impact of vaccination was assessed using a transmission model from a previously published study and updated with new data. At all levels of coverage, all strategies had a 100% probability of being cost-effective at the current National Health Service threshold, 20,000 pound/QALY gained. The incremental analysis demonstrated vaccinating Primary School children was the most cost-efficient strategy compared incrementally against others with an Incremental Cost-Effectiveness Ratio of 639 pound spent per QALY gained (Net Benefit: 404 M pound [155, 795]). When coverage was varied between 30%, 55%, and 70% strategies which included Primary school children had a higher probability of being cost-effective at lower willingness-to-pay levels. Although children were the vaccine target the majority of QALY gains occurred in the 25-44 years old and 65+ age groups. Influenza strain A/H3N2 incurred the greatest costs and QALYs lost regardless of which strategy was used. Improvement could be made to the current LAIV pediatric vaccination strategy by eliminating vaccination of 2-4 year olds and focusing on school-based delivery to Primary and Secondary school children in tandem. (C) 2020 Published by Elsevier Ltd.
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