This results in an expected QALY gain of 0.43 at incremental costs of €21,564 per 1,000 children, corresponding to an incremental cost-effectiveness ratio (ICER) of €50,297/QALY compared to no immunization. Influenza virus infections in infants. The Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics Red Book Committee have recommended that all children 6–23 months of age and their household contacts should receive annual influenza vaccination, and this policy has been widely adopted (4,5). In addition, the sensitivity of these results to the total costs of vaccination highlights the potential for delivering vaccinations in settings that have lower costs and reduce the time required for vaccination. (2006). Health Benefits, Risks, and Cost-Effectiveness of Influenza Vaccination of Children. For children not at high risk ages 6 months–4 years, we estimated that influenza vaccination with IIV would cost <$25,000 per QALY saved.
Belshe RB, Gruber WC, Mendelman PM, Cho I, Reisinger K, Block SL, et al. The probability that the cost-effectiveness of IIV would be <$30,000/QALY ranged from 51% to 89% for all children ages 6–23 months and 2 years (Figure 2). Pattern of infection in invaded households and relation of age and prior antibody to occurrence of infection and related illness. Elk Grove Village (IL): The Academy; 2001. p. 1–11. Longini Jr IJ. Health Qual Life Outcomes. We did not include any quality adjustment for vaccination itself aside from negative effects of vaccination-related adverse events. One-way sensitivity analyses on selected variables for children ages 6–23 months not at high risk, in dollars per quality-adjusted life years gained. Excluding these time costs resulted in cost-effectiveness ratios approximately half of those reported in Table 5 and Figure 2.
We explicitly asked respondents to include a parent's reduction in quality of life associated with a child's illness and any time lost from work to care for a sick child in the time-tradeoff valuation; therefore, time-tradeoff amounts could exceed the length of the event.
Monto AS, Koolman JS. Longini Jr IJ. Results should however be interpreted with caution as cost-effectiveness is largely dependent on incidence and QALY losses for fatal influenza, for which evidence is scarce. Children 6 months to 4 years were included as a theoretical intended population for LAIV, although LAIV is currently licensed in the United States only for children 5–17 years. Efficacy of vaccination with live attenuated, cold-adapted, trivalent, intranasal influenza virus vaccine against a variant (A/Sydney) not contained in the vaccine.
Am J Epidemiol. In a recent study that used cost-benefit analysis to evaluate the economics of influenza vaccination in children, Meltzer et al. Pediatrics. All vaccination strategies had net positive QALYs gained, which indicated that the health benefits of vaccination outweighed the risks (Table 4). If herd immunity effects had been included in our analysis, the findings would likely have been more favorable for vaccination. Modification of an outbreak of influenza in Tecumseh, Michigan by vaccination of schoolchildren. Acute necrotizing encephalopathy of childhood associated with influenza type B virus infection in a 3-year-old girl.
A health economic decision tree model was developed to evaluate health effects and costs of annual IIV immunization versus no immunization. Cost-effectiveness ratios based on dollars per influenza episode averted yielded patterns similar to the ratios of dollars per QALY saved, ranging from cost savings for children at high risk ages <2 years to $1,070 per influenza case averted for healthy 12- to 17-year-olds (Table 5). Health Benefits, Risks, and Cost-Effectiveness of Influenza Vaccination in ChildrenThis appendix provides additional information on methods and data and is intended to supplement the corresponding article.Equation for Calculating Cost-Effectiveness (CE) Ratios.
found that annual vaccination of children not at high risk was unlikely to be cost-saving and that annual vaccination of children 6–23 months at high risk was likely to generate cost savings. Using an alternative calculation for quality adjustments resulted in higher estimates of the projected number of QALYs gained through vaccination. Using base-case vaccine purchase prices for LAIV and IIV (Table 2), LAIV for children ages 5–17 years not at high risk had higher mean net costs and yielded greater mean health benefits than IIV. The decision tree evaluated 3 options: 1) no vaccination; 2) inactivated influenza vaccine (IIV); and 3) live, attenuated influenza vaccine (LAIV). Influenza infection and disease, 1976-1981. Pertussis in adolescents and adults: should we vaccinate? The 2-way sensitivity analyses demonstrate even less favorable cost-effectiveness for a scenario that assumes a low influenza illness rate and low level of vaccine effectiveness. Our study contributes valuable new information because it incorporates survey-based health state preferences for influenza-related illness and vaccine adverse events. For children at high risk (preexisting medical conditions) ages 6–35 months, vaccination with IIV was cost saving. Influenza vaccination can decrease the risk of influenza illness and related complications among pregnant women and their infants aged <6 months who are too young to receive the vaccine. Estimates of the US health impact of influenza. 2000;342:232–9. The cost-effectiveness ratios for LAIV were $72,000 per QALY gained for 5- to 11-year-olds and $109,000 per QALY gained for 12- to 17-year-olds (Table 5). Vaccinating with trivalent inactivated virus vaccine was more cost-effective than vaccinating with live attenuated influenza vaccine for every month. The sample sizes for the time-tradeoff studies were small.
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