Autor(es):
Sandmann, Frank ; van Leeuwen, Edwin ; Bernard-Stoecklin, Sibylle ; Casado, Itziar ; Castilla, Jesús ; Domegan, Lisa ; Gherasim, Alin ; Hooiveld, Mariëtte ; Kislaya, Irina ; Larrauri, Amparo ; Levy-Bruhl, Daniel ; Machado, Ausenda ; Marques, Diogo ; Martínez-Baz, Iván ; Mazagatos, Clara ; McMenamin, Jim ; Meijer, Adam ; Murray, Josephine ; Nunes, Baltazar ; O'Donnell, Joan ; Reynolds, Arlene ; Thorrington, Dominic ; Pebody, Richard ; Baguelin, Marc
Data: 2022
Identificador Persistente: http://hdl.handle.net/10400.18/8452
Origem: Repositório Científico do Instituto Nacional de Saúde
Assunto(s): Influenza; Vaccination; Vaccine Impact; Cost-effectiveness; Mathematical Modelling; Vacina Antigripal; Europe; Determinantes da Saúde e da Doença
Descrição
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.
