Extending the elderly- and risk-group programme of vaccination against seasonal influenza in England and Wales: a cost-effectiveness study.
Extending the elderly- and risk-group programme of vaccination against seasonal influenza in England and Wales: a cost-effectiveness study.
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DOI：
10.1186/s12916-015-0452-y
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发表时间：
2015-10-13
期刊：
影响因子：
9.3
通讯作者：
Edmunds WJ
中科院分区：
文献类型：
--
作者：
Baguelin M;Camacho A;Flasche S;Edmunds WJ
本研究旨在评估将2013年前针对高危人群和老年人的流感免疫接种计划扩展到感染季节性流感后出现并发症风险较低的人群的成本效益。我们进行了一项经济评估，比较了2013年前流感规划在7个可能的低风险个体年龄组（2-4岁、50-64岁、5-16岁、2-4和50-64岁、2-16岁和50-64岁以及2-64岁）的不同扩展。这些扩展将根据四种基本情景（无疫苗接种、仅具有1995年至2009年观察到的覆盖率的风险组、风险组和65岁以上以及覆盖率为75%且65岁以上的风险组）逐步进行评估。疫苗接种的影响是通过根据先前发表的研究建立并参数化的传播模型来评估的。研究人群是英格兰和威尔士所有年龄段的所有人，在14个流感季节（1995-2009年）平均总数为5260万人。2013年之前的流感方案（风险群体和老年人）可能具有成本效益（增量成本效益比：7,475英镑/QALY，净效益：2.53亿英镑[15-829]）。将其扩展到先前确定的任何一个低风险目标群体都可能具有成本效益。然而，不包括学龄儿童接种疫苗的战略不太可能具有成本效益。最有效的战略是扩大到5-16岁年龄组，而普遍接种疫苗（扩大到2岁以上的所有低风险个体）将获得最大的净效益。虽然延长至2-16岁年龄组可能非常具有成本效益，但延长至2-16岁以上的成本效益非常不确定。即使对其他年龄组不产生群体免疫效应，将疫苗推广到5-16岁年龄组仍可能具有成本效益。由于我们的研究包含强大的历史成分，我们的结果取决于流感疫苗的效力在很长一段时间内保持在与过去所达到的水平相似的水平（根据流行毒株和年龄组，假设在28%至70%之间变化）。利用十多年来的监测数据，结合一个动态模型，我们发现，在英国，儿童接种疫苗可能具有很高的成本效益，不仅对他们自己有利，而且还可以减少社区其他人的疾病负担。
The present study aims to evaluate the cost-effectiveness of extending the pre-2013 influenza immunisation programme for high-risk and elderly individuals to those at low risk of developing complications following infection with seasonal influenza. We performed an economic evaluation comparing different extensions of the pre-2013 influenza programme to seven possible age groups of low-risk individuals (aged 2–4 years, 50–64 years, 5–16 years, 2–4 and 50–64 years, 2–16 years, 2–16 and 50–64 years, and 2–64 years). These extensions are evaluated incrementally on four base scenarios (no vaccination, risk group only with coverage as observed between 1995 and 2009, risk group and 65+, and risk group with 75 % coverage and 65+). Impact of vaccination is assessed using a transmission model built and parameterised from a previously published study. The study population is all individuals of all ages in England and Wales representing an average total of 52.6 million people over 14 influenza seasons (1995–2009). The influenza programme (risk group and elderly) prior to 2013 is likely to be cost effective (incremental cost effectiveness ratio: 7,475 £/QALY, net benefit: 253 M£ [15–829]). Extension to any one of the low-risk target groups defined earlier is likely to be cost-effective. However, strategies that do not include vaccination of school-aged children are less likely to be cost-effective. The most efficient strategy is extension to the 5–16 year age group while universal vaccination (extension to all low-risk individuals over 2 years) will achieve the highest net benefit. While extension to the 2–16 year age group is likely to be very cost effective, the cost-effectiveness of extensions beyond 2–16 years is very uncertain. Extension to the 5–16 year age group would likely remain cost-effective even without herd immunity effects to other age groups. As our study includes a strong historical component, our results depend on the efficacy of the influenza vaccine remaining at levels similar to the ones achieved in the past over a long-period of time (assumed to vary between 28 % and 70 % depending of the circulating strains and age groups). Making use of surveillance data from over a decade in conjunction with a dynamic model, we find that vaccination of children in the United Kingdom is likely to be highly cost-effective, not only for their own benefit but also to reduce the disease burden in the rest of the community.