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PharmacoEconomics
Published in: PharmacoEconomics 8/2013

01-08-2013 | Original Research Article

Understanding the Cost-Effectiveness of Influenza Vaccination in Children: Methodological Choices and Seasonal Variability

Authors: Anthony T. Newall, Juan Pablo Dehollain, Prudence Creighton, Philippe Beutels, James G. Wood

Published in: PharmacoEconomics | Issue 8/2013

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Abstract

Background

The universal vaccination of children for influenza has recently been recommended in the UK and is being considered in other developed countries.

Objectives

The aim of this study was to explore the potential costs and benefits of childhood influenza vaccination to gain a better understanding of the key drivers of cost-effectiveness.

Methods

As our case study we examined the cost-effectiveness of vaccination in Australian schoolchildren using an age-stratified Susceptible Exposed Infectious Recovered model.

Results

The results of this study highlight the critical role that methodological choices play in determining the cost-effectiveness of influenza vaccination. These choices include decisions about the structure of the model (including/excluding herd immunity) and what costs and benefits to include in the analysis. In scenarios where herd protection was included we estimated that the program was likely to be cost-effective. The study also illustrates the importance of the inherent seasonal variability of influenza, which can produce counter-intuitive results, with low transmission seasons being easier to control by vaccination but resulting in fewer benefits.

Conclusions

Universal childhood influenza vaccination is likely to be cost-effective if a substantial herd protection effect can be achieved by the program. However, it is important that decision makers understand the role of seasonal variability and the impact of alternative methodological choices in economic evaluations of influenza vaccination.
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Literature
1.
2.
Murphy H. Vaccinating healthy children against flu is cost effective, says committee. BMJ. 2012;344:e3876.CrossRefPubMed
3.
Monto AS, Koopman JS, Longini IM Jr. Tecumseh study of illness. XIII. Influenza infection and disease, 1976–1981. Am J Epidemiol. 1985;121(6):811–22.PubMed
4.
Newall AT, Jit M, Beutels P. Economic evaluations of childhood influenza vaccination: a critical review. Pharmacoeconomics. 2012;30(8):647–60.CrossRefPubMed
5.
Kelly H, Newall AT. Mortality benefits of influenza vaccination in elderly people. Lancet Infect Dis. 2008;8(8):462–3.CrossRefPubMed
6.
Simonsen L, Taylor RJ, Viboud C, et al. Mortality benefits of influenza vaccination in elderly people: an ongoing controversy. Lancet Infect Dis. 2007;7(10):658–66.CrossRefPubMed
7.
Jefferson T, Di Pietrantonj C, Al-Ansary LA, et al. Vaccines for preventing influenza in the elderly. Cochrane Database Syst Rev 2010;(2):CD004876.
8.
Newall AT, Viboud C, Wood JG. Influenza-attributable mortality in Australians aged more than 50 years: a comparison of different modelling approaches. Epidemiol Infect. 2010;138(6):836–42.CrossRefPubMed
9.
Thompson WW, Weintraub E, Dhankhar P, et al. Estimates of US influenza-associated deaths made using four different methods. Influenza Other Respi Viruses. 2009;3(1):37–49.CrossRefPubMed
10.
Newall AT, Scuffham PA. Influenza-related disease: the cost to the Australian healthcare system. Vaccine. 2008;26(52):6818–23.CrossRefPubMed
11.
Newall AT, Wood JG, Macintyre CR. Influenza-related hospitalisation and death in Australians aged 50 years and older. Vaccine. 2008;26(17):2135–41.CrossRefPubMed
12.
Charu V, Viboud C, Simonsen L, et al. Influenza-related mortality trends in Japanese and American seniors: evidence for the indirect mortality benefits of vaccinating schoolchildren. PLoS One. 2011;6(11):e26282.CrossRefPubMed
13.
Reichert TA, Sugaya N, Fedson DS, et al. The Japanese experience with vaccinating schoolchildren against influenza. N Engl J Med. 2001;344(12):889–96.CrossRefPubMed
14.
Loeb M, Russell ML, Moss L, et al. Effect of influenza vaccination of children on infection rates in Hutterite communities: a randomized trial. JAMA. 2010;303(10):943–50.CrossRefPubMed
15.
Edmunds J, Medley GF, Nokes DJ. Evaluating the cost-effectiveness of vaccination programmes: a dynamic perspective. Stat Med. 1999;18(23):3.CrossRef
16.
Kim SY, Goldie SJ. Cost-effectiveness analyses of vaccination programmes: a focused review of modelling approaches. Pharmacoeconomics. 2008;26(3):191–215.CrossRefPubMed
17.
Brisson M, Edmunds WJ. Economic evaluation of vaccination programs: the impact of herd-immunity. Med Decis Making. 2003;23(1):76–82.CrossRefPubMed
18.
Basta NE, Chao DL, Halloran ME, et al. Strategies for pandemic and seasonal influenza vaccination of schoolchildren in the United States. Am J Epidemiol. 2009;170(6):679–86.CrossRefPubMed
19.
Vynnycky E, Pitman R, Siddiqui R, et al. Estimating the impact of childhood influenza vaccination programmes in England and Wales. Vaccine. 2008;26(41):5321–30.CrossRefPubMed
20.
Ferguson NM, Cummings DA, Cauchemez S, et al. Strategies for containing an emerging influenza pandemic in Southeast Asia. Nature. 2005;437(7056):209–14.CrossRefPubMed
21.
Ferguson NM, Cummings DA, Fraser C, et al. Strategies for mitigating an influenza pandemic. Nature. 2006;442(7101):448–52.CrossRefPubMed
22.
Germann TC, Kadau K, Longini IM Jr, et al. Mitigation strategies for pandemic influenza in the United States. Proc Natl Acad Sci USA. 2006;103(15):5935–40.CrossRefPubMed
23.
Longini IM Jr, Halloran ME, Nizam A, et al. Containing pandemic influenza with antiviral agents. Am J Epidemiol. 2004;159(7):623–33.CrossRefPubMed
24.
Longini IM Jr, Nizam A, Xu S, et al. Containing pandemic influenza at the source. Science. 2005;309(5737):1083–7.CrossRefPubMed
25.
Drummond M, Sculpher MJ, Torrance GW, et al. Methods for the economic evaluation of health care programmes. 3rd ed. Oxford: Oxford University Press; 2005.
26.
Commonwealth Department of Health and Ageing. 2006 Guidelines for the pharmaceutical industry on preparation of submissions to the Pharmaceutical Benefits Advisory Committee (PBAC) version 4.1. Canberra: Commonwealth Department of Health and Ageing; 2006.
27.
Newall AT, Dehollain JP, Wood J. Under-explored assumptions in influenza vaccination models: implications for the universal vaccination of children. Vaccine. 2012;30(39):5776–81.CrossRefPubMed
28.
Australian Bureau of Statistics. Population by age and sex, Australian states and territories (ABS catalogue number: 3201.0). Canberra: Australian Bureau of Statistics; 2010.
29.
Mossong J, Hens N, Jit M, et al. Social contacts and mixing patterns relevant to the spread of infectious diseases. PLoS Med. 2008;5(3):e74.CrossRefPubMed
30.
Agius PA, Pitts MK, Smith AMA, et al. Human papillomavirus and cervical cancer: Gardasil® vaccination status and knowledge amongst a nationally representative sample of Australian secondary school students. Vaccine. 2010;28(27):4416–22.CrossRefPubMed
31.
Australian Institute of Health and Welfare. 2009 Adult vaccination survey: summary results (AIHW catalogue number: PHE 135). Canberra: Australian Institute of Health and Welfare; 2010.
32.
Jefferson T, Di Pietrantonj C, Rivetti A, et al. Vaccines for preventing influenza in healthy adults. Cochrane Database Syst Rev 2010;7(CD001269).
33.
Vesikari T, Knuf M, Wutzler P, et al. Oil-in-water emulsion adjuvant with influenza vaccine in young children. N Engl J Med. 2012;365(15):1406–16.CrossRef
34.
Halloran ME, Haber M, Longini IM Jr. Interpretation and estimation of vaccine efficacy under heterogeneity. Am J Epidemiol. 1992;136(3):328–43.PubMed
35.
Chowell G, Miller MA, Viboud C. Seasonal influenza in the United States, France, and Australia: transmission and prospects for control. Epidemiol Infect. 2008;136(6):852–64.CrossRefPubMed
36.
Cauchemez S, Valleron AJ, Boelle PY, et al. Estimating the impact of school closure on influenza transmission from Sentinel data. Nature. 2008;452(7188):750–4.CrossRefPubMed
37.
Longini IM Jr, Koopman JS, Haber M, et al. Statistical inference for infectious diseases. Risk-specific household and community transmission parameters. Am J Epidemiol. 1988;128(4):845–59.PubMed
38.
Carrat F, Vergu E, Ferguson NM, et al. Time lines of infection and disease in human influenza: a review of volunteer challenge studies. Am J Epidemiol. 2008;167(7):775–85.CrossRefPubMed
39.
van Hoek AJ, Underwood A, Jit M, et al. The impact of pandemic influenza H1N1 on health-related quality of life: a prospective population-based study. PLoS One. 2011;6(3):e17030.CrossRefPubMed
40.
Chiu C, Dey A, Wang H, et al. Vaccine preventable diseases and vaccination coverage in Australia, 2005 to 2007. Commun Dis Intell. 2010;34:S1–167.CrossRef
41.
Brotherton J, Wang H, Schaffer A, et al. Vaccine preventable diseases and vaccination coverage in Australia, 2003 to 2005. Commun Dis Intell. 2007;31(Suppl):S1–152.
42.
43.
Municipal association of Victoria. Cost of Victorian local government immunisation services. Melbourne: Municipal Association of Victoria; 2004.
44.
Australian Government Department of Health and Ageing. Medicare benefits scheme book. Canberra: Commonwealth of Australia; 2010.
45.
Australian Government Department of Health and Aging. Medicare statistics—September quarter 2010, average patient contribution per service—out of hospital services only; 2010.
46.
47.
Australian Bureau of Statistics. Employee earnings, benefits and trade union membership, Australia, August 2010 (ABS catalogue number 6310.0). Canberra: Australian Bureau of Statistics; 2010.
48.
Lambert SB, Allen KM, Carter RC, et al. The cost of community-managed viral respiratory illnesses in a cohort of healthy preschool-aged children. Respir Res. 2008;9:11.CrossRefPubMed
49.
Australian Bureau of Statistics. Australian labour market statistics (ABS catalogue number: 6105.0). October 2010 ed. Canberra: Australian Bureau of Statistics; 2010.
50.
AIHW GP Statistics and Classification Unit. SAND abstract No 9 from the BEACH program: Influenza and absenteeism. 2000.
51.
Carrat F, Sahler C, Rogez S, et al. Influenza burden of illness: estimates from a national prospective survey of household contacts in France. Arch Intern Med. 2002;162(16):1842–8.CrossRefPubMed
52.
Australian Refined Diagnosis Related Group (AR-DRG) (version 5.1) data recorded for each public patient hospitalised under the ICD categories for pneumonia and influenza.
53.
Hawthorne G, Osborne R. Population norms and meaningful differences for the Assessment of Quality of Life (AQoL) measure. Aust N Z J Public Health. 2005;29(2):136–42.CrossRefPubMed
54.
Australian Bureau of Statistics. Life tables, Australia, 2007–2009 (ABS catalogue number: 3302.0.55.001): Commonwealth of Australia; 2010.
55.
Newall AT, Wood JG, Oudin N, et al. Cost-effectiveness of pharmaceutical-based pandemic influenza mitigation strategies. Emerg Infect Dis. 2010;16(2):224–30.CrossRefPubMed
56.
Beutels P, Scuffham PA, MacIntyre CR. Funding of drugs: do vaccines warrant a different approach? Lancet Infect Dis. 2008;8(11):727–33.CrossRefPubMed
57.
58.
Bilcke J, Beutels P, Brisson M, et al. Accounting for methodological, structural, and parameter uncertainty in decision-analytic models: a practical guide. Med Decis Making. 2011;31(4):675–92.CrossRefPubMed
59.
Griebsch I, Coast J, Brown J. Quality-adjusted life-years lack quality in pediatric care: a critical review of published cost-utility studies in child health. Pediatrics. 2005;115(5):e600–14.CrossRefPubMed
60.
Knies S, Severens JL, Ament AJHA, et al. The transferability of valuing lost productivity across jurisdictions. Differences between national pharmacoeconomic guidelines. Value Health. 2010;13(5):519–27.CrossRefPubMed
61.
Brouwer WBF, Koopmanschap MA, Rutten FFH. Productivity costs measurement through quality of life? A response to the recommendation of the Washington Panel. Health Econ. 1997;6(3):253–9.CrossRefPubMed
Metadata
Title
Understanding the Cost-Effectiveness of Influenza Vaccination in Children: Methodological Choices and Seasonal Variability
Authors
Anthony T. Newall
Juan Pablo Dehollain
Prudence Creighton
Philippe Beutels
James G. Wood
Publication date
01-08-2013
Publisher
Springer International Publishing
Published in
PharmacoEconomics / Issue 8/2013
Print ISSN: 1170-7690
Electronic ISSN: 1179-2027
DOI
https://doi.org/10.1007/s40273-013-0060-7

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