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Vaccinating children against influenza: overall cost-effective with potential for undesirable outcomes

  • de Boer, Pieter T.1
  • Backer, Jantien A.1
  • van Hoek, Albert Jan1, 2
  • Wallinga, Jacco1, 3
  • 1 National Institute for Public Health and the Environment, Antonie Van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, The Netherlands , Bilthoven (Netherlands)
  • 2 London School of Hygiene & Tropical Medicine, London, UK , London (United Kingdom)
  • 3 Leiden University Medical Center, Leiden, The Netherlands , Leiden (Netherlands)
Published Article
BMC Medicine
BioMed Central
Publication Date
Jan 14, 2020
DOI: 10.1186/s12916-019-1471-x
Springer Nature


BackgroundThe present study aims to assess the cost-effectiveness of an influenza vaccination program for children in the Netherlands. This requires an evaluation of the long-term impact of such a program on the burden of influenza across all age groups, using a transmission model that accounts for the seasonal variability in vaccine effectiveness and the shorter duration of protection following vaccination as compared to natural infection.MethodsWe performed a cost-effectiveness analysis based on a stochastic dynamic transmission model that has been calibrated to reported GP visits with influenza-like illness in the Netherlands over 11 seasons (2003/2004 to 2014/2015). We analyzed the costs and effects of extending the current program with vaccination of children aged 2–16 years at 50% coverage over 20 consecutive seasons. We measured the effects in quality-adjusted life-years (QALYs) and we adopted a societal perspective.ResultsThe childhood vaccination program is estimated to have an average incremental cost-effectiveness ratio (ICER) of €3944 per QALY gained and is cost-effective in the general population (across 1000 simulations; conventional Dutch threshold of €20,000 per QALY gained). The childhood vaccination program is not estimated to be cost-effective for the target-group itself with an average ICER of €57,054 per QALY gained. Uncertainty analyses reveal that these ICERs hide a wide range of outcomes. Even though introduction of a childhood vaccination program decreases the number of infections, it tends to lead to larger epidemics: in 23.3% of 1000 simulations, the childhood vaccination program results in an increase in seasons with a symptomatic attack rate larger than 5%, which is expected to cause serious strain on the health care system. In 6.4% of 1000 simulations, the childhood vaccination program leads to a net loss of QALYs. These findings are robust across different targeted age groups and vaccination coverages.ConclusionsModeling indicates that childhood influenza vaccination is cost-effective in the Netherlands. However, childhood influenza vaccination is not cost-effective when only outcomes for the children themselves are considered. In approximately a quarter of the simulations, the introduction of a childhood vaccination program increases the frequency of seasons with a symptomatic attack rate larger than 5%. The possibility of an overall health loss cannot be excluded.

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