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Cost effectiveness of vaccination against pandemic influenza in European countries: mathematical modelling analysis
British Medical Journal, 08/09/2012
Lugner AK et al. – No single vaccination strategy was most cost effective across countries. With aging populations, pre–existing immunity in particular could be of crucial importance for the cost effectiveness of options to mitigate a future influenza pandemic.
Methods- Economic and epidemic modelling study.
- General populations in Germany, the Netherlands, and the United Kingdom.
- Country specific patterns of social contact and demographic data.
- An age structured susceptible–exposed–infected–recovered transmission model that describes how an influenza A virus will spread in the populations of Germany, the Netherlands, and the United Kingdom.
- Comparison of four vaccination strategies: no vaccination, blanket vaccination, vaccination of elderly people (≥65 years), and vaccination of high transmitters (5–19 years).
- The four strategies were evaluated for scenarios in which a vaccine became available early or at the peak of the pandemic, and in which either everyone was initially susceptible or older age groups had pre–existing immunity.
- Cost per quality adjusted life years (QALYs) gained.
- All vaccination strategies were cost effective (incremental cost per QALY gained, comparing intervention with non–intervention).
- In scenarios where the vaccine became available at the peak of the pandemic and there was pre–existing immunity among elderly people the incremental cost effectiveness ratios for vaccinating high transmitters were €7325 (£5815; $10470) per QALY gained for Germany, €10216 per QALY gained for the Netherlands, and €7280 per QALY gained for the United Kingdom.
- The most cost effective strategy not only differed across the pandemic scenarios but also between countries.
- Specifically, when the vaccine was available early in the pandemic and there was no pre–existing immunity, in Germany it would be most cost effective to vaccinate elderly people ( €940 per QALY gained), whereas it would be most cost effective to vaccinate high transmitters in both the Netherlands (€525 per QALY gained) and the United Kingdom (€163 per QALY gained).
- This difference in optimal strategies was due to differences in the demographic characteristics of the countries: Germany has a significantly higher proportion of elderly people compared with the Netherlands and the United Kingdom.
