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. 2013 Jul;9(7):1500-11.
doi: 10.4161/hv.24704. Epub 2013 May 31.

Influenza vaccines in low and middle income countries: a systematic review of economic evaluations

Jördis J Ott  1 , Janna Klein Breteler, John S Tam, Raymond C W Hutubessy, Mark Jit, Michiel R de Boer
Affiliations

Influenza vaccines in low and middle income countries: a systematic review of economic evaluations

Jördis J Ott et al. Hum Vaccin Immunother. 2013 Jul.

Abstract

Objectives: Economic evaluations on influenza vaccination from low resource settings are scarce and have not been evaluated using a systematic approach. Our objective was to conduct a systematic review on the value for money of influenza vaccination in low- and middle-income countries.

Methods: PubMed and EMBASE were searched for economic evaluations published in any language between 1960 and 2011. Main outcome measures were costs per influenza outcome averted, costs per quality-adjusted life years gained or disability-adjusted life years averted, costs per benefit in monetary units or cost-benefit ratios.

Results: Nine economic evaluations on seasonal influenza vaccine met the inclusion criteria. These were model- or randomized-controlled-trial (RCT)-based economic evaluations from middle-income countries. Influenza vaccination provided value for money for elderly, infants, adults and children with high-risk conditions. Vaccination was cost-effective and cost-saving for chronic obstructive pulmonary disease patients and in elderly above 65 y from model-based evaluations, but conclusions from RCTs on elderly varied.

Conclusion: Economic evaluations from middle income regions differed in population studied, outcomes and definitions used. Most findings are in line with evidence from high-income countries highlighting that influenza vaccine is likely to provide value for money. However, serious methodological limitations do not allow drawing conclusions on cost-effectiveness of influenza vaccination in middle income countries. Evidence on cost-effectiveness from low-income countries is lacking altogether, and more information is needed from full economic evaluations that are conducted in a standardized manner.

Keywords: cost analysis; developing countries; economic evaluation; influenza; systematic review; vaccines.

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Figure 1. Flow diagram of economic evaluations on seasonal and pandemic A (H1N1) 2009 influenza vaccines in LMICs.
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