Influenza Vaccination Implementation in Sri Lanka: A Cost-Effectiveness Analysis

Area of Science:

• Public Health
• Health Economics
• Epidemiology

Background:

• Influenza poses a significant global health burden, causing millions of severe illnesses annually, particularly in low- and middle-income countries.
• Sri Lanka currently lacks national influenza vaccination policies and public healthcare provision for vaccines.

Purpose of the Study:

• To conduct a cost-effectiveness analysis of implementing trivalent inactivated influenza vaccination (TIV) for the Sri Lankan population.
• To evaluate the economic impact and health benefits of introducing a national influenza vaccination program.

Main Methods:

• A static Markov model was developed to simulate a cohort of Sri Lankans across three age groups (0-4, 5-64, 65+ years).
• Two scenarios were compared: TIV implementation versus no TIV, from a governmental national perspective.
• Probabilistic and one-way sensitivity analyses were performed to assess influential variables and uncertainty.

Main Results:

• The TIV strategy reduced influenza cases by 20,710, hospitalizations by 438, and deaths by 20 annually compared to no vaccination.
• Universal vaccination was found to be cost-effective, with an incremental cost-effectiveness ratio (ICER) of approximately 874,890.55 Rs/DALY averted (3624.84 USD/DALY averted).
• Key sensitivities included vaccine coverage and cost in the 5-64 age group, and vaccine effectiveness and coverage in the under-5 age group.

Conclusions:

• Providing influenza vaccines in Sri Lanka is highly cost-effective compared to the current absence of a vaccination policy.
• The study highlights the potential for significant health gains and economic benefits through vaccination.
• Further large-scale national studies with enhanced data are recommended to refine estimates and guide implementation strategies.