Influenza vaccination of the at-risk adults and elderly: measuring the long-term cost-effectiveness in an Argentinean Managed Care Organization

A systematic review of the social and economic burden of influenza in low- and middle-income countries

OBJECTIVES

The economic burden of seasonal influenza outbreaks as well as influenza pandemics in lower- and middle-income countries (LMIC) has yet to be specifically systematically reviewed. The aim of this systematic review is to assess the evidence of influenza economic burden assessment methods in LMIC and to quantify the economic consequences of influenza disease in these countries, including broader opportunity costs in terms of impaired social progress and economic development.

METHODS

We conducted an all language literature search across 5 key databases using an extensive list of key words for the time period 1950-2013. We included studies which explored direct costs (medical and non-medical), indirect costs (productivity losses), and broader economic impact in LMIC associated with different influenza outcomes such as confirmed seasonal influenza infection, influenza-like illnesses, and pandemic influenza.

RESULTS

We included 62 full-text studies in English, Spanish, Russian, Chinese languages, mostly from the countries of Latin American and the Caribbean and East Asia and Pacific with pertinent cost data found in 39 papers. Estimates for direct and indirect costs were the highest in Latin American and the Caribbean. Compared to high-income economies, direct costs in LMIC were lower and productivity losses higher. Evidence on broader impact of influenza included impact on the wider national economy, security dimension, medical insurance policy, legal frameworks, distributional impact, and investment flows.

CONCLUSION

The economic burden of influenza in LMIC encompasses multiple dimensions such as direct costs to the health service and households, indirect costs due to productivity losses as well as broader detriments to the wider economy. Evidence from sub-Saharan Africa and in pregnant women remains very limited. Heterogeneity of methods used to estimate cost components makes data synthesis challenging. There is a strong need for standardizing research, data collection and evaluation methods for both direct and indirect cost components.

2005 and 2006 seasonal influenza vaccination coverage rates in 10 countries in Africa, Asia Pacific, Europe, Latin America and the Middle East

Recommendations for seasonal influenza vaccination are standard in most developed countries. Many rapidly developing countries have recently begun to adopt recommendations for high-risk target groups, such as the elderly. Population-based surveys to determine use, rather than purchases, of seasonal influenza vaccine are rare outside North America and Western Europe. Such surveys can provide important information on the progress of national immunization programs and on the awareness of influenza among the general public. We report the results of a survey conducted in 10 countries in Africa, Asia Pacific, Eastern Europe, Latin America and the Middle East that aimed to determine influenza vaccination coverage among adults, the elderly, and children and to find out how influenza is perceived in these regions. Seasonal influenza vaccine coverage varied markedly across countries, and no single factor guaranteed high coverage. Our results indicate that strong recommendations appear insufficient, and that fully funded immunization programs together with high awareness in the population are key to encouraging high influenza vaccination coverage.