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Published on: August 14, 2019
Cost-effectiveness of live-attenuated influenza vaccination among school-age children
Natasha S Wenzel1, Katherine E Atkins2, Edwin van Leeuwen3
1Department of Epidemiology, University of Washington, Seattle 98195, USA; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle 98109, USA.
Insights
Prioritizing influenza vaccination for primary school children is a cost-effective strategy, improving health outcomes for all age groups. This approach optimizes the pediatric vaccination program by focusing resources efficiently.
Area of Science:
- Public Health
- Health Economics
- Epidemiology
Background:
- The current pediatric influenza vaccination program in England and Wales uses Live-Attenuated Influenza Vaccine (LAIV) for children aged 2-16.
- Annual LAIV administration presents significant costs and logistical challenges.
Purpose of the Study:
- To evaluate the cost-effectiveness of prioritizing specific age groups within the 2-16 year range for influenza vaccination.
- To identify strategies that mitigate operational and resource challenges of the current program.
Main Methods:
- Economic evaluation comparing the existing program (1995-2013) with seven alternative strategies targeting school-age divisions (Preschool, Primary, Secondary).
- Utilized a transmission model updated with new data to assess the impact of vaccination.
- Assessed cost-effectiveness against the National Health Service threshold of £20,000/QALY gained.
Main Results:
- All evaluated strategies demonstrated 100% probability of cost-effectiveness at the NHS threshold.
- Vaccinating Primary School children emerged as the most cost-efficient strategy (ICER: £639/QALY gained).
- The majority of Quality-Adjusted Life Year (QALY) gains were observed in the 25-44 and 65+ age groups, despite children being the vaccine target.
Conclusions:
- Optimizing the LAIV pediatric vaccination strategy could involve eliminating vaccination for 2-4 year olds.
- Focusing on school-based delivery to Primary and Secondary school children offers improved cost-effectiveness and resource utilization.
- Influenza strain A/H3N2 was associated with the highest costs and QALY losses across all strategies.
Abstract:
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/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 spent per QALY gained (Net Benefit: 404 M£ [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.
