Béraud Guillaume, Mosnier Anne, Guérin Olivier, Cugnardey Nathalie, Gillet Sandrine, Haond Justine, Simon Stéphane, Berkovitch Quentin, Gamblin Pierre, Lesage Henri, Loubet Paul
Department of Infectious Diseases, University Hospital of Orléans, 45000, Orléans, France.
LI²RSO, University of Orléans, 45000, Orléans, France.
Infect Dis Ther. 2025 Jun 8. doi: 10.1007/s40121-025-01168-5.
Influenza in France causes, on average, more than 1 million primary care consultations, 20,000 hospitalizations, and 9000 deaths annually. Adults over 50 years of age face higher risks of severe influenza due to increasing chronic conditions associated with aging, yet vaccination rates in this group are low, as recommendations start from age 65. This study explores the potential health and economic benefits of expanding vaccination recommendations to individuals aged 50 and over.
Using the literature and French health insurance data, a SEIR (susceptible-exposed-infectious-recovered) model was developed. The subpopulations were stratified by age, vaccination status, and risk profile. Various expanded vaccination strategies were compared to the current strategy, assessing impacts on epidemiological outcomes (consultations, hospitalizations, deaths), economic metrics (vaccination costs, medical care expenses), and quality-adjusted life years (QALY). The model's robustness was tested with deterministic and probabilistic sensitivity analyses.
Expanded vaccination recommendations for individuals over 50 years of age lead to an average reduction of 500,124 consultations, 9486 hospitalizations, and 2990 deaths, with an associated additional cost of 58 million euros compared to the current vaccination strategy. The cost-effectiveness analysis estimates an incremental cost-effectiveness ratio (ICER) of €1496/QALY. When considering indirect costs, the total savings in this expanded vaccination scenario amount to €- 314,308,377, resulting in a dominant ICER. This indicates that the strategy would not only be more cost-effective but also cost-saving compared to the current approach.
Expanding vaccination recommendations for low-risk adults over 50 is cost-effective and represents a significant public health opportunity.
在法国，流感平均每年导致超过100万次初级保健门诊、2万例住院治疗以及9000人死亡。50岁以上的成年人由于与衰老相关的慢性疾病增多，面临着更高的严重流感风险，但该年龄段的疫苗接种率较低，因为目前的接种建议起始年龄为65岁。本研究探讨了将疫苗接种建议扩大至50岁及以上人群可能带来的健康和经济效益。
利用文献和法国医疗保险数据，建立了一个SEIR（易感-暴露-感染-康复）模型。亚人群按年龄、疫苗接种状况和风险特征进行分层。将各种扩大疫苗接种策略与当前策略进行比较，评估对流行病学结果（门诊、住院、死亡）、经济指标（疫苗接种成本、医疗费用）以及质量调整生命年（QALY）的影响。通过确定性和概率性敏感性分析对模型的稳健性进行了测试。
与当前疫苗接种策略相比，将疫苗接种建议扩大至50岁以上人群平均可减少500,124次门诊、9486例住院治疗以及2990人死亡，相关额外成本为5800万欧元。成本效益分析估计增量成本效益比（ICER）为1496欧元/QALY。考虑间接成本时，在这种扩大疫苗接种的情况下，总节省金额达-314,308,377欧元，从而产生了优势ICER。这表明该策略不仅更具成本效益，而且与当前方法相比还能节省成本。
将疫苗接种建议扩大至50岁以上低风险成年人具有成本效益，是一个重大的公共卫生机遇。
