Effects of Adverse Events on the Projected Population Benefits and Cost-effectiveness of Using Live Attenuated Influenza Vaccine in Children Aged 6 Months to 4 Years
Division of General Pediatrics, University of Michigan Health System, 300 N Ingalls Street, Ann Arbor, MI 48109, USA. JAMA Pediatrics
(Impact Factor: 5.73).
10/2010; 165(2):112-8. DOI: 10.1001/archpediatrics.2010.182
To evaluate the effect of adverse events associated with live attenuated influenza vaccine (LAIV) in children younger than 5 years on the cost-effectiveness of influenza vaccination.
A decision analytic model was developed to predict costs and health effects of no vaccination, vaccination with LAIV, and vaccination with inactivated influenza vaccine (IIV). Probabilities, costs, and quality adjustments for uncomplicated influenza, outpatient visits, hospitalizations, deaths, vaccination, and vaccine adverse events were based on primary and published data. The analysis included the possible increased incidence of adverse events following vaccination with LAIV for children younger than 5 years, including fever, wheezing, and hospitalization. A societal perspective was used. Sensitivity analyses, including probabilistic sensitivity analysis, were conducted.
Vaccination in the physician office setting in the United States.
Hypothetical cohorts of healthy children aged 6 months to 4 years.
Vaccination with LAIV or IIV.
Incremental cost-effectiveness ratio in dollars per quality-adjusted life-year (QALY).
Cost-effectiveness ratios ranged from $20 000/QALY (age 6-23 months) to $33 000/QALY (age 3-4 years) for LAIV and from $21 000/QALY to $37 000/QALY for IIV for healthy children aged 6 months to 4 years. Inclusion of possible new adverse events for LAIV had varying effects on cost-effectiveness results. Results were not sensitive to the inclusion of wheezing as an adverse event but were sensitive to a possible increase in the probability of hospitalization.
Live attenuated influenza vaccine had comparable cost-effectiveness compared with IIV for children younger than 5 years under a wide range of assumptions about the incidence of adverse events.
Available from: Javier González de Dios
Available from: Matthew Biggerstaff
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ABSTRACT: From April 2009 through March 2010, during the pandemic (H1N1) 2009 outbreak, ≈8.2 million prescriptions for influenza neuraminidase-inhibiting antiviral drugs were filled in the United States. We estimated the number of hospitalizations likely averted due to use of these antiviral medications. After adjusting for prescriptions that were used for prophylaxis and personal stockpiles, as well as for patients who did not complete their drug regimen, we estimated the filled prescriptions prevented ≈8,400-12,600 hospitalizations (on the basis of median values). Approximately 60% of these prevented hospitalizations were among adults 18-64 years of age, with the remainder almost equally divided between children 0-17 years of age and adults >65 years of age. Public health officials should consider these estimates an indication of success of treating patients during the 2009 pandemic and a warning of the need for renewed planning to cope with the next pandemic.
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ABSTRACT: Influenza viruses continue to cause disease of varying severity among humans. People with underlying disease and the elderly are at increased risk of developing severe disease after infection with an influenza virus. As effective and safe vaccines are available, the WHO has recommended vaccinating these groups against influenza annually. In addition to this recommendation, public health authorities of a number of countries have recently recommended vaccinating all healthy children aged 6-59 months against influenza. Here, we review the currently available data concerning the burden of disease in children, the economical impact of implementing universal vaccination of children, the efficacy of currently available influenza virus vaccines, the theoretical concerns regarding preventing immunity otherwise induced by infections with seasonal influenza viruses, and finally, how to address these concerns.
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