UK Health Security Agency, London NW9 5EQ, United Kingdom.; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine (LSHTM), London, UK.
UK Health Security Agency, London NW9 5EQ, United Kingdom.; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine (LSHTM), London, UK.
Vaccine. 2022 Feb 23;40(9):1306-1315. doi: 10.1016/j.vaccine.2022.01.015. Epub 2022 Jan 31.
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).
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%.
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.
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.
尽管大多数国家的季节性流感疫苗接种计划针对的是年龄≥65 岁（或≥55 岁）的人群和高风险人群，但仍存在显著的疾病负担。我们在八个欧洲国家（共 2.058 亿人）中，研究了 27 项针对老年人和/或儿童的疫苗接种计划的影响和成本效益。
我们使用年龄结构动态传播模型，根据英格兰、法国、爱尔兰、纳瓦拉、荷兰、葡萄牙、苏格兰和西班牙 2010/11 年至 2017/18 年的数据，推断出年龄和（亚）型特异性季节性流感病毒感染情况，并对其进行校准。基本疫苗接种方案包括非佐剂、非高剂量三价疫苗（TV）和非普遍儿童疫苗接种。我们探讨了以下几种方案：i）将老年人接种改良型（即佐剂或高剂量）三价疫苗（iTV）或非佐剂非高剂量四价疫苗（QV）；ii）采用 TV 或 QV 对儿童进行大规模疫苗接种；iii）结合老年人和儿童的接种策略。我们从医疗保健角度估计了各设定点的成本和获得的质量调整生命年（QALY），并将 QALY 贴现率设为 3.0%。
在老年人中，接种改良型 TV 或 QV 后，每 10 万人的感染人数分别减少了 261.5（设定点范围：154.4，475.7）和 150.8（77.6，262.3）。通过间接保护，接种 25%的儿童大规模疫苗接种计划可以使老年人的感染人数减少 233.6（使用 TV 的范围为 58.9，425.6）或 266.5（使用 QV 的范围为 65.7，477.9），在所有设定点和儿童接种率水平下，均可避免感染，从而获得显著的健康收益。在 35000 欧元/QALY 获益的情况下，接种改良型 TV 和接种普遍儿童 QV 疫苗计划，为所有设定点提供了最高的平均净收益和具有成本效益的概率。
鉴于直接和间接保护，以及疫苗价格，模型结果支持在所有欧洲设定点采取将老年人接种改良疫苗和采用普遍儿童疫苗接种计划相结合的策略。
