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van Heuvel L, Paget J, Dückers M, Caini S. The impact of influenza and pneumococcal vaccination on antibiotic use: an updated systematic review and meta-analysis. Antimicrob Resist Infect Control 2023; 12:70. [PMID: 37452389 PMCID: PMC10347879 DOI: 10.1186/s13756-023-01272-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Vaccination can prevent bacterial and viral infections that could otherwise increase the chances of receiving (unnecessary) antibiotic treatment(s). As a result, vaccination may provide an important public health intervention to control antimicrobial resistance (AMR). OBJECTIVES Perform a systematic literature review to better understand the impact of influenza, pneumococcal and COVID-19 vaccination on antibiotic use, and to identify differences in effect between world regions and study designs. METHODS We performed a systematic literature review and meta-analysis which updated previous literature reviews with new data from 1 October 2018 to 1 December 2021. The study focuses on randomised controlled trials (RCTs) and observational studies. Results from the meta-analysis of RCTs were stratified by WHO region and age group. Vote counting based on the direction of effect was applied to synthesize the results of the observational studies. RESULTS Most studies are performed in the WHO European Region and the Region of the Americas in high-income countries. RCTs show that the effect of influenza vaccination on the number of antibiotic prescriptions or days of antibiotic use (Ratio of Means (RoM) 0.71, 95% CI 0.62-0.83) is stronger compared to the effect of pneumococcal vaccination (RoM 0.92, 95% CI 0.85-1.00). These studies also confirm a reduction in the proportion of people receiving antibiotics after influenza vaccination (Risk Ratio (RR) 0.63, 95% CI 0.51-0.79). The effect of influenza vaccination in the European and American regions ranged from RoM 0.63 and 0.87 to RR 0.70 and 0.66, respectively. The evidence from observational studies supports these findings but presents a less consistent picture. No COVID-19 studies were identified. CONCLUSION We find that both RCTs and observational studies show that influenza vaccination significantly reduces antibiotic use, while the effect of pneumococcal vaccination is less pronounced. We were unable to study the effect of COVID-19 vaccination and no clear regional patterns were found due to the high heterogeneity between studies. Overall, our data supports the use of influenza vaccination as an important public health intervention to reduce antibiotic use and possibly control AMR.
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Affiliation(s)
- Lotte van Heuvel
- Netherlands Institute for Health Services Research (Nivel), Otterstraat 118, 3513 CR, Utrecht, The Netherlands
| | - John Paget
- Netherlands Institute for Health Services Research (Nivel), Otterstraat 118, 3513 CR, Utrecht, The Netherlands.
| | - Michel Dückers
- Netherlands Institute for Health Services Research (Nivel), Otterstraat 118, 3513 CR, Utrecht, The Netherlands
- ARQ Centre of Expertise for the Impact of Disasters and Crises, Diemen, The Netherlands
- Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Saverio Caini
- Netherlands Institute for Health Services Research (Nivel), Otterstraat 118, 3513 CR, Utrecht, The Netherlands
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Kim DeLuca E, Gebremariam A, Rose A, Biggerstaff M, Meltzer MI, Prosser LA. Cost-effectiveness of routine annual influenza vaccination by age and risk status. Vaccine 2023:S0264-410X(23)00495-4. [PMID: 37291022 DOI: 10.1016/j.vaccine.2023.04.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND The epidemiology of circulating seasonal influenza strains changed following the 2009 pandemic influenza A(H1N1). A universal influenza vaccination recommendation has been implemented and new vaccine types have become available post-2009. The objective of this study was to evaluate the cost-effectiveness of routine annual influenza vaccination in the context of this new evidence. METHODS A state transition simulation model was constructed to estimate the health and economic outcomes of influenza vaccination compared to no vaccination for hypothetical US cohorts stratified by age and risk status. Model input parameters were derived from multiple sources, including post-2009 vaccine effectiveness data from the US Flu Vaccine Effectiveness Network. The analysis used societal and healthcare sector perspectives and a one-year time horizon, except permanent outcomes were also included. The primary outcome was the incremental cost-effectiveness ratio (ICER) in dollars per quality-adjusted life years (QALYs) gained. RESULTS Compared to no vaccination, vaccination yielded ICERs lower than $95,000/QALY for all age and risk groups, except for non-high-risk adults 18-49 years ($194,000/QALY). Vaccination was cost-saving for adults ≥50 years at higher risk for influenza-related complications. Results were most sensitive to changes in the probability of influenza illness. Performing the analysis from the healthcare sector perspective, excluding vaccination time costs, delivering vaccinations in lower-cost settings, and including productivity losses improved the cost-effectiveness of vaccination. Sensitivity analysis revealed that vaccination remains below $100,000/QALY for older persons ≥65 years at vaccine effectiveness estimates as low as 4 %. CONCLUSIONS Cost-effectiveness of influenza vaccination varied by age and risk status and was less than $95,000/QALY for all subgroups, except for non-high-risk working-age adults. Results were sensitive to the probability of influenza illness and vaccination was more favorable under certain scenarios. Vaccination for higher risk subgroups resulted in ICERs below $100,000/QALY even at low levels of vaccine effectiveness or circulating virus.
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Affiliation(s)
- Ellen Kim DeLuca
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States; Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Acham Gebremariam
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Angela Rose
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Matthew Biggerstaff
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Martin I Meltzer
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Lisa A Prosser
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States; Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States.
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Buckley BS, Henschke N, Bergman H, Skidmore B, Klemm EJ, Villanueva G, Garritty C, Paul M. Impact of vaccination on antibiotic usage: a systematic review and meta-analysis. Clin Microbiol Infect 2019; 25:1213-1225. [PMID: 31284031 DOI: 10.1016/j.cmi.2019.06.030] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/19/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Vaccines may reduce antibiotic use and the development of resistance. OBJECTIVES To provide a comprehensive, up-to-date assessment of the evidence base relating to the effect of vaccines on antibiotic use. DATA SOURCES Ovid MEDLINE, Embase, the Cochrane Library, ClinicalTrials.gov and WHO Trials Registry. STUDY ELIGIBILITY CRITERIA Randomized controlled trials (RCTs) and observational studies published from January 1998 to March 2018. PARTICIPANTS Any population. INTERVENTIONS Vaccines versus placebo, no vaccine or another vaccine. METHODS Titles, abstracts and full-texts were screened independently by two reviewers. Certainty of RCT evidence was assessed using GRADE. RESULTS In all, 4980 records identified; 895 full-text reports assessed; 96 studies included (24 RCTs, 72 observational). There was high-certainty evidence that influenza vaccine reduces days of antibiotic use among healthy adults (one RCT; n = 4253; rate reduction 28·1%; 95% CI 16·0-38·4); moderate-certainty evidence that influenza vaccines probably reduce antibiotic use in children aged 6 months to 14 years (three RCTs; n = 610; ratio of means 0·62; 95% CI 0·54-0·70) and probably reduce community antibiotic use in children aged 3-15 years (one RCT; n = 10 985 person-seasons; risk ratio 0·69, 95% CI 0·58-0·83); and moderate-certainty evidence that pneumococcal vaccination probably reduces antibiotic use in children aged 6 weeks to 6 years (two RCTs; n = 47 945; rate ratio 0·93, 95% CI 0·87-0·99) and reduces illness episodes requiring antibiotics in children aged 12-35 months (one RCT; n = 264; rate ratio 0·85, 95% CI 0·75-0·97). Other RCT evidence was of low or very low certainty, and observational evidence was affected by confounding. CONCLUSIONS The evidence base is poor. Although some vaccines may reduce antibiotic use, collection of high-quality data in future vaccine trials is needed to improve the evidence base. PROSPERO REGISTRATION CRD42018103881.
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Affiliation(s)
- B S Buckley
- Department of Surgery, University of the Philippines Manila, Philippine General Hospital, Manila, Philippines; Cochrane Response, Cochrane, London, UK
| | - N Henschke
- Cochrane Response, Cochrane, London, UK.
| | - H Bergman
- Cochrane Response, Cochrane, London, UK
| | - B Skidmore
- Independent Information Specialist, Ottawa, ON, Canada
| | | | | | - C Garritty
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - M Paul
- Institute of Infectious Diseases, Rambam Health Care Campus, Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Hart RJ, Stevenson MD, Smith MJ, LaJoie AS, Cross K. Cost-effectiveness of Strategies for Offering Influenza Vaccine in the Pediatric Emergency Department. JAMA Pediatr 2018; 172:e173879. [PMID: 29114729 PMCID: PMC6583269 DOI: 10.1001/jamapediatrics.2017.3879] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Influenza is a significant public health burden, causing morbidity and mortality in children, yet vaccination rates remain low. Vaccination in the pediatric emergency department (PED) setting may be beneficial but, to date, has not been proven to be cost-effective. OBJECTIVE To compare the cost-effectiveness of 4 strategies for PED-based influenza vaccine: offering vaccine to all patients, only to patients younger than 5 years, only to high-risk patients (all ages), or to no patients. DESIGN, SETTING, AND PARTICIPANTS Using commercial decision analysis software, a cost-effectiveness analysis was performed from January 1, 2016, to June 1, 2017, to compare influenza vaccine strategies at a tertiary, urban, freestanding PED with an estimated 60 000 visits per year among a hypothetical cohort of children visiting the above PED during influenza season. Sensitivity analyses estimated the effect of uncertainties across a variety of input variables (eg, influenza prevalence, vaccine price and effectiveness, and costs of complications). MAIN OUTCOMES AND MEASURES The primary outcomes were cost and incremental cost-effectiveness ratio in dollars per influenza case averted. Secondary outcomes included total societal costs, hospitalizations and deaths averted, and quality-adjusted life-years gained. RESULTS Offering influenza vaccine to all eligible patients has the lowest cost, at $114.45 (95% CI, $55.48-$245.45) per case of influenza averted. This strategy saves $33.51 (95% CI, $18-$62) per case averted compared with no vaccination, and averages 27 fewer cases of influenza per 1000 patients. Offering vaccine to all patients resulted in 0.72 days (95% CI, 0.18-1.78 days) of quality-adjusted life-years lost, whereas offering to none resulted in 0.91 days (95% CI, 0.25-2.2 days) of quality-adjusted life-years lost. In sensitivity analyses, this strategy remains robustly cost-effective across a wide range of assumptions. In addition to being the most cost-effective strategy regardless of age or risk status, routine vaccination in the PED results in a net societal monetary benefit under many circumstances. In Monte Carlo analysis, offering vaccine to all patients was superior to other strategies in at least 99.8% of cases. CONCLUSIONS AND RELEVANCE Although few PEDs routinely offer influenza vaccination, doing so appears to be cost-effective, with the potential to significantly reduce the economic (and patient) burden of pediatric influenza.
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Affiliation(s)
- Rebecca J. Hart
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - Michelle D. Stevenson
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - Michael J. Smith
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - A. Scott LaJoie
- Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky
| | - Keith Cross
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville, Louisville, Kentucky
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Influenza vaccine use to protect healthy children: A debated topic. Vaccine 2017; 36:5391-5396. [PMID: 28928077 DOI: 10.1016/j.vaccine.2017.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 08/19/2017] [Accepted: 09/01/2017] [Indexed: 11/20/2022]
Abstract
At the beginning of this century, a number of studies suggested that in healthy children, particularly those <2years of age, influenza could have a serious and complicated course, as it frequently led to hospitalization and sometimes, albeit rarely, to death. Moreover, pre-schoolers and school-age children were found to be among the most important causes of influenza transmission to the community, as they shed the virus for a longer time than adults and had frequent contact with greater numbers of individuals through day-care and school. These findings led a number of health authorities to modify the official recommendations regarding the use of influenza vaccine in healthy children. Several factors seem to indicate that vaccination against influenza in healthy children of any age and in pregnant women could be effective in preventing the disease in the entire paediatric population and in providing herd immunity in adults and old people as well. The direct advantages of the vaccine seem greater in younger subjects, particularly those <2-3years of age. Vaccination of older children is considered effective by most experts, but high vaccination coverage of these subjects has been difficult to attain. Similar difficulties have been identified for the vaccination of pregnant women. These challenges can be overcome, at least in part, by appropriate information and accurate evaluations of available data. In addition, further studies specifically designed to clarify unresolved problems regarding vaccine use in paediatric and pregnant populations are needed to convince reluctant health authorities. More effective vaccines for younger children as well as improved availability of data regarding the optimal time period for vaccine administration in pregnant women appear relevant in this regard.
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Jacob V, Chattopadhyay SK, Hopkins DP, Murphy Morgan J, Pitan AA, Clymer JM. Increasing Coverage of Appropriate Vaccinations: A Community Guide Systematic Economic Review. Am J Prev Med 2016; 50:797-808. [PMID: 26847663 PMCID: PMC4896867 DOI: 10.1016/j.amepre.2015.11.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 10/22/2015] [Accepted: 11/02/2015] [Indexed: 11/16/2022]
Abstract
CONTEXT Population-level coverage for immunization against many vaccine-preventable diseases remains below optimal rates in the U.S. The Community Preventive Services Task Force recently recommended several interventions to increase vaccination coverage based on systematic reviews of the evaluation literature. The present study provides the economic results from those reviews. EVIDENCE ACQUISITION A systematic review was conducted (search period, January 1980 through February 2012) to identify economic evaluations of 12 interventions recommended by the Task Force. Evidence was drawn from included studies; estimates were constructed for the population reach of each strategy, cost of implementation, and cost per additional vaccinated person because of the intervention. Analyses were conducted in 2014. EVIDENCE SYNTHESIS Reminder systems, whether for clients or providers, were among the lowest-cost strategies to implement and the most cost effective in terms of additional people vaccinated. Strategies involving home visits and combination strategies in community settings were both costly and less cost effective. Strategies based in settings such as schools and MCOs that reached the target population achieved additional vaccinations in the middle range of cost effectiveness. CONCLUSIONS The interventions recommended by the Task Force differed in reach, cost, and cost effectiveness. This systematic review presents the economic information for 12 effective strategies to increase vaccination coverage that can guide implementers in their choice of interventions to fit their local needs, available resources, and budget.
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Affiliation(s)
- Verughese Jacob
- Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia.
| | - Sajal K Chattopadhyay
- Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia
| | - David P Hopkins
- Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia
| | - Jennifer Murphy Morgan
- Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia
| | - Adesola A Pitan
- Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia
| | - John M Clymer
- National Forum for Heart Disease and Stroke Prevention, Washington, District of Columbia
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8
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Schuller KA, Probst JC. Factors associated with influenza vaccination among US children in 2008. J Infect Public Health 2013; 6:80-8. [DOI: 10.1016/j.jiph.2012.12.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 12/06/2012] [Accepted: 12/12/2012] [Indexed: 11/25/2022] Open
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Salleras L, Navas E, Torner N, Prat AA, Garrido P, Soldevila N, Domínguez A. Economic benefits of inactivated influenza vaccines in the prevention of seasonal influenza in children. Hum Vaccin Immunother 2013; 9:707-11. [PMID: 23295894 PMCID: PMC3891732 DOI: 10.4161/hv.23269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 10/31/2012] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to systematically review published studies that evaluated the efficiency of inactivated influenza vaccination in preventing seasonal influenza in children. The vaccine evaluated was the influenza-inactivated vaccine in 10 studies and the virosomal inactivated vaccine in 3 studies. The results show that yearly vaccination of children with the inactivated influenza vaccine saves money from the societal and family perspectives but not from the public or private provider perspective. When vaccination does not save money, the cost-effectiveness ratios were very acceptable. It can be concluded, that inactivated influenza vaccination of children is a very efficient intervention.
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Affiliation(s)
- Luis Salleras
- Department of Public Health; School of Medicine; University of Barcelona; Barcelona, Spain
- Public Health Agency of Catalonia; Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP); Madrid, Spain
| | | | - Nuria Torner
- Department of Public Health; School of Medicine; University of Barcelona; Barcelona, Spain
- Public Health Agency of Catalonia; Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP); Madrid, Spain
| | - Andreu A. Prat
- Department of Public Health; School of Medicine; University of Barcelona; Barcelona, Spain
| | - Patricio Garrido
- Department of Public Health; School of Medicine; University of Barcelona; Barcelona, Spain
| | - Núria Soldevila
- CIBER Epidemiología y Salud Pública (CIBERESP); Madrid, Spain
| | - Angela Domínguez
- Department of Public Health; School of Medicine; University of Barcelona; Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP); Madrid, Spain
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Mahamud A, Fiebelkorn AP, Nelson G, Aguon A, McKenna J, Villarruel G, Gallagher K, Ortega-Sánchez IR. Economic impact of the 2009-2010 Guam mumps outbreak on the public health sector and affected families. Vaccine 2012; 30:6444-8. [PMID: 22902678 DOI: 10.1016/j.vaccine.2012.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 07/30/2012] [Accepted: 08/01/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND The United States Territory of Guam reported a large mumps outbreak of 505 cases during 2009-2010. We assessed the economic impact of the outbreak from the perspectives of the local public health sector and affected families. METHODS Using standard cost analysis methods, we retrospectively identified all public health personnel involved in the outbreak response and surveyed them about their outbreak-related activities. We then estimated the costs of outbreak-related personnel hours and materials. We also assessed out-of-pocket costs and costs incurred for work-time missed for persons with mumps and their families. We defined the analysis period as February 25-October 22, 2010. RESULTS Seventy-six public health personnel were involved in outbreak response activities. Overall, the response required approximately 8264 person-hours, 2380 miles driven, and 3000 doses of measles-mumps-rubella vaccine ordered. The cost to the public health sector was 256,785 U.S. dollars (USD). Families of 102 persons with mumps were interviewed. An estimated 761 USD per person with mumps was spent by families; 88% of this cost was due to missed days of work. The estimated total cost to families of the 470 persons with mumps during the analysis period was 357,670 USD. Total outbreak-related costs were 614,455 USD. CONCLUSIONS The costs reported underscore the impact of mumps outbreaks in highly vaccinated populations and the need for effective mumps prevention and control strategies.
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Affiliation(s)
- Abdirahman Mahamud
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, United States.
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Newall AT, Jit M, Beutels P. Economic evaluations of childhood influenza vaccination: a critical review. PHARMACOECONOMICS 2012; 30:647-660. [PMID: 22788257 DOI: 10.2165/11599130-000000000-00000] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The potential benefits of influenza vaccination programmes targeted at children have gained increasing attention in recent years. We conducted a literature search of economic evaluations of influenza vaccination in those aged ≤18 years. The search revealed 20 relevant articles, which were reviewed. The studies differed widely in terms of the costs and benefits that were included. The conclusions were generally favourable for vaccination, but often applied a wider perspective (i.e. including productivity losses) than the reference case for economic evaluations used in many countries. Several evaluations estimated outcomes from a single-year epidemiological study, which may limit their validity given the year-to-year variation in influenza transmissibility, virulence, vaccine match and prior immunity. Only one study used a dynamic transmission model able to fully incorporate the indirect herd protection to the wider community. The use of dynamic models offers great scope to capture the population-wide implications of seasonal vaccination efforts, particularly those targeted at children.
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Affiliation(s)
- Anthony T Newall
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
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Ortega-Sanchez IR, Molinari NAM, Fairbrother G, Szilagyi PG, Edwards KM, Griffin MR, Cassedy A, Poehling KA, Bridges C, Staat MA. Indirect, out-of-pocket and medical costs from influenza-related illness in young children. Vaccine 2012; 30:4175-81. [DOI: 10.1016/j.vaccine.2012.04.057] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 04/09/2012] [Accepted: 04/16/2012] [Indexed: 11/28/2022]
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Infections Associated with Group Childcare. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASES 2012. [PMCID: PMC7152480 DOI: 10.1016/b978-1-4377-2702-9.00102-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Children have high rates of healthcare utilization due to influenza. In addition, children also transmit influenza to others in their households and the community. The costs of influenza in children include the direct medical care costs from increased outpatient visits and hospitalizations, and also indirect costs due to productivity losses especially for their parents and due to transmission of the virus to others. A variety of studies using different methods and assumptions have assessed the cost-effectiveness of influenza vaccination of children, and many find that vaccination is either cost saving or cost effective.
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Prosser LA, Lavelle TA, Fiore AE, Bridges CB, Reed C, Jain S, Dunham KM, Meltzer MI. Cost-effectiveness of 2009 pandemic influenza A(H1N1) vaccination in the United States. PLoS One 2011; 6:e22308. [PMID: 21829456 PMCID: PMC3146485 DOI: 10.1371/journal.pone.0022308] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 06/23/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pandemic influenza A(H1N1) (pH1N1) was first identified in North America in April 2009. Vaccination against pH1N1 commenced in the U.S. in October 2009 and continued through January 2010. The objective of this study was to evaluate the cost-effectiveness of pH1N1 vaccination. METHODOLOGY A computer simulation model was developed to predict costs and health outcomes for a pH1N1 vaccination program using inactivated vaccine compared to no vaccination. Probabilities, costs and quality-of-life weights were derived from emerging primary data on pH1N1 infections in the US, published and unpublished data for seasonal and pH1N1 illnesses, supplemented by expert opinion. The modeled target population included hypothetical cohorts of persons aged 6 months and older stratified by age and risk. The analysis used a one-year time horizon for most endpoints but also includes longer-term costs and consequences of long-term sequelae deaths. A societal perspective was used. Indirect effects (i.e., herd effects) were not included in the primary analysis. The main endpoint was the incremental cost-effectiveness ratio in dollars per quality-adjusted life year (QALY) gained. Sensitivity analyses were conducted. RESULTS For vaccination initiated prior to the outbreak, pH1N1 vaccination was cost-saving for persons 6 months to 64 years under many assumptions. For those without high risk conditions, incremental cost-effectiveness ratios ranged from $8,000-$52,000/QALY depending on age and risk status. Results were sensitive to the number of vaccine doses needed, costs of vaccination, illness rates, and timing of vaccine delivery. CONCLUSIONS Vaccination for pH1N1 for children and working-age adults is cost-effective compared to other preventive health interventions under a wide range of scenarios. The economic evidence was consistent with target recommendations that were in place for pH1N1 vaccination. We also found that the delays in vaccine availability had a substantial impact on the cost-effectiveness of vaccination.
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Affiliation(s)
- Lisa A Prosser
- Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan Health System, Ann Arbor, Michigan, United States of America.
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Palmer LA, Rousculp MD, Johnston SS, Mahadevia PJ, Nichol KL. Effect of influenza-like illness and other wintertime respiratory illnesses on worker productivity: The child and household influenza-illness and employee function (CHIEF) study. Vaccine 2010; 28:5049-56. [DOI: 10.1016/j.vaccine.2010.05.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 04/29/2010] [Accepted: 05/05/2010] [Indexed: 11/24/2022]
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Lugnér AK, Mylius SD, Wallinga J. Dynamic versus static models in cost-effectiveness analyses of anti-viral drug therapy to mitigate an influenza pandemic. HEALTH ECONOMICS 2010; 19:518-31. [PMID: 19382106 DOI: 10.1002/hec.1485] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Conventional (static) models used in health economics implicitly assume that the probability of disease exposure is constant over time and unaffected by interventions. For transmissible infectious diseases this is not realistic and another class of models is required, so-called dynamic models. This study aims to examine the differences between one dynamic and one static model, estimating the effects of therapeutic treatment with antiviral (AV) drugs during an influenza pandemic in the Netherlands. Specifically, we focus on the sensitivity of the cost-effectiveness ratios to model choice, to the assumed drug coverage, and to the value of several epidemiological factors. Therapeutic use of AV-drugs is cost-effective compared with non-intervention, irrespective of which model approach is chosen. The findings further show that: (1) the cost-effectiveness ratio according to the static model is insensitive to the size of a pandemic, whereas the ratio according to the dynamic model increases with the size of a pandemic; (2) according to the dynamic model, the cost per infection and the life-years gained per treatment are not constant but depend on the proportion of cases that are treated; and (3) the age-specific clinical attack rates affect the sensitivity of cost-effectiveness ratio to model choice.
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Affiliation(s)
- Anna K Lugnér
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control Netherlands, Epidemiology and Surveillance Unit, Bilthoven, The Netherlands.
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19
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Routine use of influenza vaccine. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2009. [PMID: 19280852 DOI: 10.1007/978-0-387-79838-7_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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20
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Cost-effectiveness of live attenuated influenza vaccine versus inactivated influenza vaccine among children aged 24-59 months in the United States. Vaccine 2008; 26:2841-8. [PMID: 18462851 DOI: 10.1016/j.vaccine.2008.03.046] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 03/14/2008] [Accepted: 03/20/2008] [Indexed: 11/22/2022]
Abstract
BACKGROUND The US Advisory Committee on Immunization Practices (ACIP) recently expanded the influenza vaccine recommendation to include children 24-59 months of age. In a large head-to-head randomized controlled trial, live attenuated influenza vaccine, trivalent (LAIV) demonstrated a 54% relative reduction in culture-confirmed influenza illness compared with trivalent inactivated influenza vaccine (TIV) among children aged 24-59 months. OBJECTIVE To evaluate the relative cost and benefit between two influenza vaccines (LAIV and TIV) for healthy children 24-59 months of age. METHODS Using patient-level data from the clinical trial supplemented with cost data from published literature, we modeled the cost-effectiveness of these two vaccines. Effectiveness was measured in quality-adjusted life years (QALY) and cases of influenza avoided. The analysis used the societal perspective. RESULTS Due to its higher acquisition cost, LAIV increased vaccination costs by USD7.72 per child compared with TIV. However, compared with TIV, LAIV reduced the number of influenza illness cases and lowered the subsequent healthcare use of children and productivity losses of parents. The estimated offsets in direct and indirect costs saved USD15.80 and USD37.72 per vaccinated child, respectively. LAIV had a net total cost savings of USD45.80 per child relative to TIV. One-way and probabilistic sensitivity analyses indicated that the model was robust across a wide range of relative vaccine efficacy and cost estimates. CONCLUSIONS Due to its increased relative vaccine efficacy over TIV, LAIV reduced the burden of influenza and lowered both direct health care and societal costs among children 24-59 months of age.
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Goossens LMA, Standaert B, Hartwig N, Hövels AM, Al MJ. The cost-utility of rotavirus vaccination with Rotarix™ (RIX4414) in the Netherlands. Vaccine 2008; 26:1118-27. [PMID: 18215445 DOI: 10.1016/j.vaccine.2007.11.070] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Revised: 11/14/2007] [Accepted: 11/19/2007] [Indexed: 01/14/2023]
Affiliation(s)
- Lucas M A Goossens
- Institute for Medical Technology Assessment, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Shane AL, Pickering LK. Infections Associated with Group Childcare. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASE 2008. [PMCID: PMC7310925 DOI: 10.1016/b978-0-7020-3468-8.50009-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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23
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Savidan E, Chevat C, Marsh G. Economic evidence of influenza vaccination in children. Health Policy 2007; 86:142-52. [PMID: 18054109 DOI: 10.1016/j.healthpol.2007.09.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Revised: 07/13/2007] [Accepted: 09/17/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We review published economic evaluations of influenza vaccination for children, including direct individual benefits and indirect societal benefits, to determine whether more studies are needed to fully understand the expected benefits of such strategies. METHODS We searched MEDLINE and EMBASE databases to May 2006 and in-press articles to October 2006 for studies including economic analyses of influenza vaccination in children. Abstracts of all potentially relevant articles were screened. RESULTS Fifteen relevant articles from 1983 were retained. Most were based on modelling, using previously published data and considered the societal perspective. Three were a part of prospective clinical trials. Various paediatric vaccination scenarios and parameters were considered. Vaccinating children against influenza was cost saving or cost effective in 10/15 studies, cost saving or effective only under certain conditions in three studies, and not cost saving or effective in two studies whatever the outcome or perspective considered. CONCLUSIONS Most published evidence points to an economic interest for society of vaccinating children against influenza. However, differences in study design hinder the comparison of the various vaccination strategies considered. Comparable and complete data on the burden and cost of disease, and the cost of vaccination are needed, especially outside of North America.
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Affiliation(s)
- Emmanuelle Savidan
- Global Pricing, Health Economics and Modelling Department, Sanofi Pasteur, Lyon, France
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Hibbert CL, Piedra PA, McLaurin KK, Vesikari T, Mauskopf J, Mahadevia PJ. Cost-effectiveness of live-attenuated influenza vaccine, trivalent in preventing influenza in young children attending day-care centres. Vaccine 2007; 25:8010-20. [PMID: 17936446 DOI: 10.1016/j.vaccine.2007.09.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Revised: 08/29/2007] [Accepted: 09/06/2007] [Indexed: 11/16/2022]
Abstract
Vaccinating children at day-care may be a cost-effective approach for improving influenza immunization rates in this high-risk group. This study uses influenza attack-rate data from a randomized, blinded, placebo-controlled clinical trial of live-attenuated influenza vaccine, trivalent in day-care centres from two consecutive influenza seasons, one with a moderate attack rate (H1N1 dominant) and one with a high attack rate (H3N2 dominant). Costs were measured in US dollars. In the moderate attack-rate season (vaccinated, 2.2%; placebo, 13.4%), vaccination saved US$ 5.47 per child in societal costs. In the high attack-rate season (vaccinated, 4.7%; placebo, 32.1%), vaccination led to a societal costs savings of US$ 144.44 per child.
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Affiliation(s)
- Clare L Hibbert
- RTI Health Solutions, Williams House, Manchester Science Park, Lloyd Street North, Manchester M15 6SE, United Kingdom.
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26
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Abstract
PURPOSE OF REVIEW This review summarizes recent studies that better address the burden of influenza from the medical and socioeconomic perspectives. The issue of influenza in children is one that has implications for future universal vaccination policies. RECENT FINDINGS In the past, the burden of influenza in children was largely defined by hospital-based studies that quantify the incidence of influenza hospitalization and, consequently, the benefit of prevention in young children. The medical and the socioeconomic impact have been better appreciated recently with population-based studies because the great majority of children are managed as outpatients. Children with influenza may not have direct contact with medical services but still generate substantial costs in carer illness or work-day loss. Furthermore, the specificity offered by laboratory confirmation of influenza has enabled influenza to be separated from other respiratory viruses that may have confounded previous studies looking at the medical and economic costs of illness. SUMMARY Better understanding of the burden of influenza in healthy children regarding hospitalization rates, outpatient medical visits, community-managed illness and socioeconomic impact on families and society exists; this has potential implications for universal vaccination policies under consideration.
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Affiliation(s)
- Mary Iskander
- National Centre for Immunisation Research and Surveillance, Children Hospital at Westmead, Westmead, New South Wales, Australia.
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Prosser LA, Bridges CB, Uyeki TM, Hinrichsen VL, Meltzer MI, Molinari NAM, Schwartz B, Thompson WW, Fukuda K, Lieu TA. Health benefits, risks, and cost-effectiveness of influenza vaccination of children. Emerg Infect Dis 2007; 12:1548-58. [PMID: 17176570 PMCID: PMC3290928 DOI: 10.3201/eid1210.051015] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Vaccinating children aged 6–23 months, plus all other children at high-risk, will likely be more effective than vaccinating all children against influenza. We estimated cost-effectiveness of annually vaccinating children not at high risk with inactivated influenza vaccine (IIV) to range from US $12,000 per quality-adjusted life year (QALY) saved for children ages 6–23 months to $119,000 per QALY saved for children ages 12–17 years. For children at high risk (preexisting medical conditions) ages 6–35 months, vaccination with IIV was cost saving. For children at high risk ages 3–17 years, vaccination cost $1,000–$10,000 per QALY. Among children not at high risk ages 5–17 years, live, attenuated influenza vaccine had a similar cost-effectiveness as IIV. Risk status was more important than age in determining the economic effects of annual vaccination, and vaccination was less cost-effective as the child's age increased. Thus, routine vaccination of all children is likely less cost-effective than vaccination of all children ages 6–23 months plus all other children at high risk.
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Affiliation(s)
- Lisa A Prosser
- Harvard Medical School, Boston, Massachusetts 02215, USA
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Principi N, Esposito S. Influenza vaccination in healthy children. Vaccine 2007; 25:401. [PMID: 16996664 DOI: 10.1016/j.vaccine.2006.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2006] [Revised: 08/14/2006] [Accepted: 08/16/2006] [Indexed: 10/24/2022]
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Esposito S, Marchisio P, Bosis S, Lambertini L, Claut L, Faelli N, Bianchi C, Colombo GL, Principi N. Clinical and economic impact of influenza vaccination on healthy children aged 2-5 years. Vaccine 2005; 24:629-35. [PMID: 16157429 DOI: 10.1016/j.vaccine.2005.08.054] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2005] [Revised: 06/21/2005] [Accepted: 08/08/2005] [Indexed: 11/27/2022]
Abstract
This paper reports the data concerning the net economic cost savings attributable to influenza vaccination in healthy children aged 2-5 years, and may be useful when deciding the best recommendations for the use of influenza vaccine in pediatrics. A total of 303 previously unprimed healthy children aged 2-5 years (163 males; mean age+/-S.D.: 3.22+/-2.43 years) were prospectively, blindly randomised in a 2:1 ratio to receive two doses of an inactivated, trivalent, virosome-formulated subunit influenza vaccine (Inflexal V, Berna Biotech, Berne, Switzerland) or no vaccination. The results show that influenza vaccination of healthy children aged 2-5 years substantially reduces influenza-like illnesses and related costs in the children themselves and their families. However, larger and longer running study spanning multiple seasons may be warranted before suggesting the universal vaccination of this group of subjects.
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Affiliation(s)
- Susanna Esposito
- Institute of Pediatrics, Pediatric Department 1, University of Milan, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Via Commenda 9, 20122 Milano, Italy
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