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Cost-Effectiveness of Pediatric Influenza Vaccination in The Netherlands
Pieter T de Boer1, Lisa Nagy1, Franklin C K Dolk2
1Unit of PharmacoTherapy, -Epidemiology, and -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
Insights
Extending the Dutch influenza vaccination program to include children is cost-saving. Pediatric vaccination significantly reduces disease burden and saves millions of euros annually.
Area of Science:
- Public Health
- Epidemiology
- Health Economics
Background:
- Influenza vaccination programs primarily target elderly and high-risk groups.
- The potential impact of pediatric influenza vaccination on disease burden and cost-effectiveness is not fully understood.
Purpose of the Study:
- To evaluate the cost-effectiveness of extending the Dutch influenza vaccination program to include children.
- To assess the impact of pediatric vaccination on influenza transmission and economic outcomes, considering indirect protection.
Main Methods:
- An age-structured dynamic transmission model was developed and calibrated using influenza-associated GP visits.
- The model simulated various pediatric vaccination strategies over 20 years, comparing clinical and economic impacts.
Main Results:
- Vaccinating children aged 2-17 years with a live-attenuated vaccine was estimated to avert over 400,000 symptomatic cases and 72 deaths annually.
- Herd immunity from pediatric vaccination prevented nearly all averted deaths in other age groups.
- The strategy was cost-saving, generating significant quality-adjusted life-years (QALYs) gained and substantial cost savings.
Conclusions:
- Introducing pediatric influenza vaccination in the Netherlands is a cost-saving measure.
- Pediatric vaccination substantially reduces the overall influenza-related disease burden.
Objective:
This study evaluates the cost-effectiveness of extending the Dutch influenza vaccination program for elderly and medical high-risk groups to include pediatric influenza vaccination, taking indirect protection into account.
Methods:
An age-structured dynamic transmission model was used that was calibrated to influenza-associated GP visits over 4 seasons (2010-2011 to 2013-2014). The clinical and economic impact of different pediatric vaccination strategies were compared over 20 years, varying the targeted age range, the vaccine type for children or elderly and high-risk groups. Outcome measures include averted symptomatic infections and deaths, societal costs and quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Costs and QALYs were discounted at 4% and 1.5% annually.
Results:
At an assumed coverage of 50%, adding pediatric vaccination for 2- to 17-year-olds with quadrivalent live-attenuated vaccine to the current vaccination program for elderly and medical high-groups with quadrivalent inactivated vaccine was estimated to avert, on average, 401 820 symptomatic cases and 72 deaths per year. Approximately half of averted symptomatic cases and 99% of averted deaths were prevented in other age groups than 2- to 17-year-olds due to herd immunity. The cumulative discounted 20-year economic impact was 35 068 QALYs gained and €1687 million saved, that is, the intervention was cost-saving. This vaccination strategy had the highest probability of being the most cost-effective strategy considered, dominating pediatric strategies targeting 2- to 6-year-olds or 2- to 12-year-olds or strategies with trivalent inactivated vaccine.
Conclusion:
Modeling indicates that introducing pediatric influenza vaccination in The Netherlands is cost-saving, reducing the influenza-related disease burden substantially.
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