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. 2022 Feb 23;40(9):1306-1315.
doi: 10.1016/j.vaccine.2022.01.015. Epub 2022 Jan 31.

Health and economic impact of seasonal influenza mass vaccination strategies in European settings: A mathematical modelling and cost-effectiveness analysis

Frank G Sandmann  1 , Edwin van Leeuwen  2 , Sibylle Bernard-Stoecklin  3 , Itziar Casado  4 , Jesús Castilla  4 , Lisa Domegan  5 , Alin Gherasim  6 , Mariëtte Hooiveld  7 , Irina Kislaya  8 , Amparo Larrauri  6 , Daniel Levy-Bruhl  3 , Ausenda Machado  8 , Diogo F P Marques  9 , Iván Martínez-Baz  4 , Clara Mazagatos  6 , Jim McMenamin  9 , Adam Meijer  10 , Josephine L K Murray  9 , Baltazar Nunes  8 , Joan O'Donnell  5 , Arlene Reynolds  9 , Dominic Thorrington  11 , Richard Pebody  12 , Marc Baguelin  13
Affiliations

Health and economic impact of seasonal influenza mass vaccination strategies in European settings: A mathematical modelling and cost-effectiveness analysis

Frank G Sandmann et al. Vaccine. .

Abstract

Introduction: Despite seasonal influenza vaccination programmes in most countries targeting individuals aged ≥ 65 (or ≥ 55) years and high risk-groups, significant disease burden remains. We explored the impact and cost-effectiveness of 27 vaccination programmes targeting the elderly and/or children in eight European settings (n = 205.8 million).

Methods: We used an age-structured dynamic-transmission model to infer age- and (sub-)type-specific seasonal influenza virus infections calibrated to England, France, Ireland, Navarra, The Netherlands, Portugal, Scotland, and Spain between 2010/11 and 2017/18. The base-case vaccination scenario consisted of non-adjuvanted, non-high dose trivalent vaccines (TV) and no universal paediatric vaccination. We explored i) moving the elderly to "improved" (i.e., adjuvanted or high-dose) trivalent vaccines (iTV) or non-adjuvanted non-high-dose quadrivalent vaccines (QV); ii) adopting mass paediatric vaccination with TV or QV; and iii) combining the elderly and paediatric strategies. We estimated setting-specific costs and quality-adjusted life years (QALYs) gained from the healthcare perspective, and discounted QALYs at 3.0%.

Results: In the elderly, the estimated numbers of infection per 100,000 population are reduced by a median of 261.5 (range across settings: 154.4, 475.7) when moving the elderly to iTV and by 150.8 (77.6, 262.3) when moving them to QV. Through indirect protection, adopting mass paediatric programmes with 25% uptake achieves similar reductions in the elderly of 233.6 using TV (range: 58.9, 425.6) or 266.5 using QV (65.7, 477.9), with substantial health gains from averted infections across ages. At €35,000/QALY gained, moving the elderly to iTV plus adopting mass paediatric QV programmes provides the highest mean net benefits and probabilities of being cost-effective in all settings and paediatric coverage levels.

Conclusion: Given the direct and indirect protection, and depending on the vaccine prices, model results support a combination of having moved the elderly to an improved vaccine and adopting universal paediatric vaccination programmes across the European settings.

Keywords: Economic evaluation; Influenza; Mathematical model; Policy; Public health; Vaccination.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Settings included in the cost-effectiveness analysis, and all partner countries participating in the Integrated Monitoring of Vaccines in Europe project, I-MOVE+ .Note: Partner countries participating in the EU-funded I-MOVE+ project but not in this cost-effectiveness analysis are coloured in dark grey; countries not part of the I-MOVE+ project are coloured in light grey. Shapefiles with country borders were taken from Eurostat GISCO (https://ec.europa.eu/eurostat/web/gisco). EU: European Union, I-MOVE+: Integrated Monitoring of Vaccines in Europe project, M: million.
Fig. 2
Fig. 2
Mean reduction of influenza virus infections per 100,000 population across vaccination strategies and settings by age groups of children and adolescents (0–14 years), adults (15–64 years), and the elderly (65 + years). Note that the epidemiological model explored paediatric mass vaccination for individuals up to age 16.eld.: elderly vaccination change (moving from TV to iTV or QV), iTV: “improved” trivalent vaccine (i.e., adjuvanted or high-dose), paed.: paediatric mass vaccination (scenario with specified vaccine and uptake rate), QV: quadrivalent vaccine (non-adjuvanted, non-high dose), TV: trivalent vaccine (non-adjuvanted, non-high dose).
Fig. 3
Fig. 3
Mean number of events averted per 100,000 doses, across all ages and settings. Note that the wide range of uncertainty is reflecting the impact observed in different settings. Elderly solo programmes in blue, paediatric solo programmes in orange-red, combination programmes in pink-purple.eld.: elderly vaccination change (moving from TV to iTV or QV), GP: general practitioner, ILI: influenza-like illness, iTV: “improved” trivalent vaccine (i.e., adjuvanted or high-dose), paed.: paediatric mass vaccination (scenario with specified vaccine and uptake rate), QV: quadrivalent vaccine (non-adjuvanted, non-high dose), TV: trivalent vaccine (non-adjuvanted, non-high dose).
Fig. 4
Fig. 4
Change in total costs and QALYs per strategy in each setting.eld.: elderly vaccination change (moving from TV to iTV or QV), EUR: euros, iTV: “improved” trivalent vaccine (i.e., adjuvanted or high-dose), paed.: paediatric mass vaccination (scenario with specified vaccine and uptake rate), QALY: quality-adjusted life year, QV: quadrivalent vaccine (non-adjuvanted, non-high dose), TV: trivalent vaccine (non-adjuvanted, non-high dose).
Fig. 5
Fig. 5
Optimal vaccination strategy for willingness-to-pay ranges of €0-€45,000/QALY per paediatric uptake scenario and per setting (based on cost-effectiveness acceptability frontier, CEAF). Note: Grey vertical bars indicate local cost-effectiveness thresholds used officially or unofficially in each settingCEAF: cost-effectiveness acceptability frontier, eld.: elderly vaccination change (moving from TV to iTV or QV), EN: England, ES: Spain, FR: France, IE: Ireland, iTV: “improved” trivalent vaccine (i.e., adjuvanted or high-dose), NL: Netherlands, NV: Navarra, paed.: paediatric mass vaccination (scenario with specified vaccine and uptake rate), PT: Portugal, QALY: quality-adjusted life year, QV: quadrivalent vaccine (non-adjuvanted, non-high dose), SC: Scotland, TV: trivalent vaccine (non-adjuvanted, non-high dose).
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