Influenza can cause significant morbidity and mortality. Influenza vaccination is an effective and safe strategy in the prevention of influenza. Currently the National Health Service (NHS) vaccinates 'at-risk' individuals only. This definition includes everyone over 65 years of age but excludes individuals 50-64 years of age unless they have an additional risk factor, such as underlying heart disease or lung disease. In order to examine the cost-effectiveness of an extension of the vaccination policy to include this age group we constructed an economic model to estimate the costs and benefits of vaccination from both a health service and a societal perspective. Data to populate the model was obtained from the literature and the outcome measure used was the quality adjusted life year (QALY). Influenza vaccination prevented an estimated 4508 cases (95% CI: 2431-7606) per 100,000 vaccinees per influenza season for a net cost to the NHS of pound653,221 (95% CI: 354,575-1,072,257). The net cost increased to pound1,139,069 (95% CI 27,052-2,030,473) when non-NHS costs were included and the estimated cost-per-QALY were pound6174 and pound10,766 for NHS and all costs respectively. Extension of the current immunisation policy has the potential to generate a significant health benefit at a comparatively low cost.
"The impact and economic rationale of country-specific recommendations is not always well established, and indeed was recently debated in the United Kingdom. Some economic models have examined the impact of extending recommendations to other groups such as children under 12 years or adults 50–64 years  . However, most of these are static models that do not realistically model infection transmission, and hence indirect protection in non-vaccinated individuals such as Abbreviations: GP, general practitioner; GPRD, General Practice Research Database; ILI, influenza-like illness; QALY, quality-adjusted life year; RCGP, Royal College of General Practitioners. "
[Show abstract][Hide abstract] ABSTRACT: The seasonal influenza vaccination programme in England targets individuals over 65 years old and in clinical risk groups.
A model of influenza transmission and disease was fitted to weekly primary care consultations due to influenza in a typical pre-pandemic season (2006/2007). Different scenarios were constructed about influenza severity and how well vaccines match circulating strains to assess the impact and cost-effectiveness of the current vaccination programme.
A well-matched vaccine may reduce the incidence of laboratory-confirmed influenza illness from 8.2% (95% range 4.3-13%) to 5.9% (95% range 2.9-9.7%), with 56-73% of this due to indirect protection. The programme is likely to be cost-effective unless both low severity and poor matching is assumed.
The current seasonal influenza vaccination programme appears to substantially reduce disease burden and provides good value for money.
"A growing body of evidence indicates vaccination of healthy adults is often cost-saving   . Recently, the cost-effectiveness of universal influenza vaccination in those aged 50-64 years in Europe reported favourable results   . "
[Show abstract][Hide abstract] ABSTRACT: Currently the Australian government funds universal influenza vaccine for all those aged > or =65 years under the National Immunisation Program (NIP). Annual vaccination rates in those aged 50-64 years are significantly lower than vaccination rates in those aged > or =65 years, and currently less than half those at high-risk of influenza-related complications aged 50-64 years are immunised. This study used a decision tree model to examine the cost-effectiveness of lowering the age threshold for the influenza NIP in Australia to include those aged 50-64 years. From a healthcare payer perspective, a new influenza vaccination policy would cost $8908/QALY gained. From a societal perspective, a new influenza vaccination policy would cost $8338/QALY gained. From a governmental perspective, a new influenza vaccination policy would cost $22,408/QALY gained. The most influential parameters in deterministic sensitivity analysis included: probability of death due to influenza, vaccine efficacy against mortality, vaccine uptake, vaccine cost, and vaccine administration cost. Influenza vaccination for people aged 50-64 years appears highly cost-effective, and should be a strong candidate for funding under the NIP.
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