Systematic review of the cost-effectiveness of influenza immunization programs |
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| Institution: | 1. Institute of Health Policy, Management & Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada;2. Program of Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, 11th floor, 686 Bay Street, Toronto, ON M5G 0A4, Canada;3. AstraZeneca Canada Inc., 1004 Middlegate Road, Mississauga, ON L4Y 1M4, Canada;4. Public Health Ontario, #300 - 480 University Avenue, Toronto, ON M5G 1V2, Canada;1. Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium;2. Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Hasselt University, Hasselt, Belgium;3. Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium;4. School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia;1. Institute for Translational Vaccinology, Intravacc, Bilthoven, The Netherlands;2. Initiative for Vaccine Research Team, Immunization, Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland;3. Director and Principal Consultant, Environmental Pathogens P/L, Canberra, ACT 2612, Australia;4. Technology Transfer Initiative Team, Universal Health Coverage and Health Systems Department, World Health Organization, Geneva, Switzerland;5. Initiative for Vaccine Research Team, Immunization, Vaccines and Biologicals Department, Geneva, Switzerland;6. Inserm, 101, Paris, France;1. Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong;2. Health Economics and Health Technology Assessment, Institute of Health & Wellbeing, University of Glasgow, United Kingdom;3. School of Public Health, The University of Hong Kong, Hong Kong;1. Centre for Mathematics, Physics and Engineering in the Life Sciences and Experimental Biology, University College London, London, UK;2. Clinical and Operational Research Unit, Department of Mathematics, University College London, London, UK;3. Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK;4. Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK;5. Respiratory Diseases Department, Public Health England, London, UK;6. Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK;7. Department of Infectious Disease Epidemiology, Medical Research Council Centre for Outbreak Analyses and Modelling, School of Public Health, Imperial College London, London, UK;1. Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States;2. Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa;3. U.S. Public Health Service, Rockville, MD, United States;4. Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa;5. School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;6. Communicable Disease Cluster, National Department of Health, South Africa;7. Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa;8. Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa;1. Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California;2. Department of Epidemiology, UCLA Jonathan and Karin Fielding School of Public Health, University of California–Los Angeles, Los Angeles, California;3. Evidence-based Synthesis Program, West Los Angeles VA Medical Center, Los Angeles, California;4. Rand Health, RAND Corporation, Santa Monica, California;5. Department of Statistics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia |
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| Abstract: | BackgroundSeasonal influenza immunization programs vary widely across jurisdictions. In Canada, some provinces offer universal programs while others target specific population groups. However, whether targeted or universal programs provide more benefit and value-for-money is unclear. The cost-effectiveness of influenza immunization programs was systematically reviewed to inform policy.MethodsCitation databases and the grey literature were searched for economic evaluations of influenza immunization programs. Eligible studies were appraised using the Scottish Intercollegiate Guidelines Network (SIGN) checklist with supplemental WHO vaccine-related questions. Data from high quality studies was extracted and the studies reviewed.ResultsA total of 41influenza immunization studies were identified. Of these, 31 were high quality. For pregnant and postpartum women, vaccinating all versus only high risk women study results ranged from dominance (less costly and more effective) to $9773 per QALY gained (societal) and from dominance to $58,000 per QALY gained (healthcare system). Studies of vaccinating all versus only high risk children found vaccination to be dominant to $47,000 per QALY gained (societal), and dominant to $18,000 per QALY gained (healthcare system). Vaccinating high risk adults was highly cost-effective and vaccinating health care workers resulted in $35,000 per QALY gained. Results for healthy working adults were mixed and sensitive to vaccine uptake, efficacy, and productivity loss.ConclusionsFrom the societal perspective, vaccination was cost-effective for children, pregnant and postpartum women, high risk groups, and in some cases, healthy working age adults. Immunization programs using group administration are more cost-effective than programs using individual administration. The perspective, programmatic design, setting, and inclusion of herd immunity affects cost-effectiveness. In regions with targeted programs, re-evaluating “high risk” criteria and consideration of a universal program is warranted. |
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| Keywords: | Influenza immunization Cost-effectiveness Pregnant women Children Adults High-risk |
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