Systematic review of the cost-effectiveness of influenza immunization programs.
Identifieur interne : 000106 ( Main/Curation ); précédent : 000105; suivant : 000107Systematic review of the cost-effectiveness of influenza immunization programs.
Auteurs : Eon E K. Ting [Canada] ; Beate Sander [Canada] ; Wendy J. Ungar [Canada]Source :
- Vaccine [ 1873-2518 ] ; 2017.
Descripteurs français
- KwdFr :
- MESH :
- prévention et contrôle : Grippe humaine.
- économie : Grippe humaine, Programmes de vaccination.
- épidémiologie : Canada, Grippe humaine.
- Analyse coût-bénéfice, Humains.
English descriptors
- KwdEn :
- MESH :
- economics : Immunization Programs, Influenza, Human.
- epidemiology : Canada, Influenza, Human.
- prevention & control : Influenza, Human.
- Cost-Benefit Analysis, Humans.
Abstract
BACKGROUND
Seasonal influenza immunization programs vary widely across jurisdictions. In Canada, some provinces offer universal programs while others target specific population groups. However, whether targeted or universal programs provide more benefit and value-for-money is unclear. The cost-effectiveness of influenza immunization programs was systematically reviewed to inform policy.
METHODS
Citation databases and the grey literature were searched for economic evaluations of influenza immunization programs. Eligible studies were appraised using the Scottish Intercollegiate Guidelines Network (SIGN) checklist with supplemental WHO vaccine-related questions. Data from high quality studies was extracted and the studies reviewed.
RESULTS
A total of 41influenza immunization studies were identified. Of these, 31 were high quality. For pregnant and postpartum women, vaccinating all versus only high risk women study results ranged from dominance (less costly and more effective) to $9773 per QALY gained (societal) and from dominance to $58,000 per QALY gained (healthcare system). Studies of vaccinating all versus only high risk children found vaccination to be dominant to $47,000 per QALY gained (societal), and dominant to $18,000 per QALY gained (healthcare system). Vaccinating high risk adults was highly cost-effective and vaccinating health care workers resulted in $35,000 per QALY gained. Results for healthy working adults were mixed and sensitive to vaccine uptake, efficacy, and productivity loss.
CONCLUSIONS
From the societal perspective, vaccination was cost-effective for children, pregnant and postpartum women, high risk groups, and in some cases, healthy working age adults. Immunization programs using group administration are more cost-effective than programs using individual administration. The perspective, programmatic design, setting, and inclusion of herd immunity affects cost-effectiveness. In regions with targeted programs, re-evaluating "high risk" criteria and consideration of a universal program is warranted.
DOI: 10.1016/j.vaccine.2017.02.044
PubMed: 28284681
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Ting</name><affiliation wicri:level="1"><nlm:affiliation>Institute of Health Policy, Management & Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada; Program of Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, 11th floor, 686 Bay Street, Toronto, ON M5G 0A4, Canada; AstraZeneca Canada Inc., 1004 Middlegate Road, Mississauga, ON L4Y 1M4, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Institute of Health Policy, Management & Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada; Program of Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, 11th floor, 686 Bay Street, Toronto, ON M5G 0A4, Canada; AstraZeneca Canada Inc., 1004 Middlegate Road, Mississauga, ON L4Y 1M4</wicri:regionArea></affiliation></author><author><name sortKey="Sander, Beate" sort="Sander, Beate" uniqKey="Sander B" first="Beate" last="Sander">Beate Sander</name><affiliation wicri:level="1"><nlm:affiliation>Institute of Health Policy, Management & Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada; Public Health Ontario, #300 - 480 University Avenue, Toronto, ON M5G 1V2, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Institute of Health Policy, Management & Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada; Public Health Ontario, #300 - 480 University Avenue, Toronto, ON M5G 1V2</wicri:regionArea></affiliation></author><author><name sortKey="Ungar, Wendy J" sort="Ungar, Wendy J" uniqKey="Ungar W" first="Wendy J" last="Ungar">Wendy J. Ungar</name><affiliation wicri:level="1"><nlm:affiliation>Institute of Health Policy, Management & Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada; Program of Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, 11th floor, 686 Bay Street, Toronto, ON M5G 0A4, Canada. Electronic address: wendy.ungar@sickkids.ca.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Institute of Health Policy, Management & Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada; Program of Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, 11th floor, 686 Bay Street, Toronto, ON M5G 0A4</wicri:regionArea></affiliation></author></analytic><series><title level="j">Vaccine</title><idno type="eISSN">1873-2518</idno><imprint><date when="2017" type="published">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Canada (epidemiology)</term><term>Cost-Benefit Analysis (MeSH)</term><term>Humans (MeSH)</term><term>Immunization Programs (economics)</term><term>Influenza, Human (economics)</term><term>Influenza, Human (epidemiology)</term><term>Influenza, Human (prevention & control)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Analyse coût-bénéfice (MeSH)</term><term>Canada (épidémiologie)</term><term>Grippe humaine (prévention et contrôle)</term><term>Grippe humaine (économie)</term><term>Grippe humaine (épidémiologie)</term><term>Humains (MeSH)</term><term>Programmes de vaccination (économie)</term></keywords><keywords scheme="MESH" qualifier="economics" xml:lang="en"><term>Immunization Programs</term><term>Influenza, Human</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Canada</term><term>Influenza, Human</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Influenza, Human</term></keywords><keywords scheme="MESH" qualifier="prévention et contrôle" xml:lang="fr"><term>Grippe humaine</term></keywords><keywords scheme="MESH" qualifier="économie" xml:lang="fr"><term>Grippe humaine</term><term>Programmes de vaccination</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Canada</term><term>Grippe humaine</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Cost-Benefit Analysis</term><term>Humans</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Analyse coût-bénéfice</term><term>Humains</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Seasonal influenza immunization programs vary widely across jurisdictions. In Canada, some provinces offer universal programs while others target specific population groups. However, whether targeted or universal programs provide more benefit and value-for-money is unclear. The cost-effectiveness of influenza immunization programs was systematically reviewed to inform policy.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>Citation databases and the grey literature were searched for economic evaluations of influenza immunization programs. Eligible studies were appraised using the Scottish Intercollegiate Guidelines Network (SIGN) checklist with supplemental WHO vaccine-related questions. Data from high quality studies was extracted and the studies reviewed.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>A total of 41influenza immunization studies were identified. Of these, 31 were high quality. For pregnant and postpartum women, vaccinating all versus only high risk women study results ranged from dominance (less costly and more effective) to $9773 per QALY gained (societal) and from dominance to $58,000 per QALY gained (healthcare system). Studies of vaccinating all versus only high risk children found vaccination to be dominant to $47,000 per QALY gained (societal), and dominant to $18,000 per QALY gained (healthcare system). Vaccinating high risk adults was highly cost-effective and vaccinating health care workers resulted in $35,000 per QALY gained. Results for healthy working adults were mixed and sensitive to vaccine uptake, efficacy, and productivity loss.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>From the societal perspective, vaccination was cost-effective for children, pregnant and postpartum women, high risk groups, and in some cases, healthy working age adults. Immunization programs using group administration are more cost-effective than programs using individual administration. The perspective, programmatic design, setting, and inclusion of herd immunity affects cost-effectiveness. In regions with targeted programs, re-evaluating "high risk" criteria and consideration of a universal program is warranted.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">28284681</PMID><DateCompleted><Year>2017</Year><Month>12</Month><Day>14</Day></DateCompleted><DateRevised><Year>2018</Year><Month>12</Month><Day>02</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1873-2518</ISSN><JournalIssue CitedMedium="Internet"><Volume>35</Volume><Issue>15</Issue><PubDate><Year>2017</Year><Month>04</Month><Day>04</Day></PubDate></JournalIssue><Title>Vaccine</Title><ISOAbbreviation>Vaccine</ISOAbbreviation></Journal><ArticleTitle>Systematic review of the cost-effectiveness of influenza immunization programs.</ArticleTitle><Pagination><MedlinePgn>1828-1843</MedlinePgn></Pagination><ELocationID EIdType="pii" ValidYN="Y">S0264-410X(17)30247-5</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.vaccine.2017.02.044</ELocationID><Abstract><AbstractText Label="BACKGROUND">Seasonal influenza immunization programs vary widely across jurisdictions. In Canada, some provinces offer universal programs while others target specific population groups. However, whether targeted or universal programs provide more benefit and value-for-money is unclear. The cost-effectiveness of influenza immunization programs was systematically reviewed to inform policy.</AbstractText><AbstractText Label="METHODS">Citation databases and the grey literature were searched for economic evaluations of influenza immunization programs. Eligible studies were appraised using the Scottish Intercollegiate Guidelines Network (SIGN) checklist with supplemental WHO vaccine-related questions. Data from high quality studies was extracted and the studies reviewed.</AbstractText><AbstractText Label="RESULTS">A total of 41influenza immunization studies were identified. Of these, 31 were high quality. For pregnant and postpartum women, vaccinating all versus only high risk women study results ranged from dominance (less costly and more effective) to $9773 per QALY gained (societal) and from dominance to $58,000 per QALY gained (healthcare system). Studies of vaccinating all versus only high risk children found vaccination to be dominant to $47,000 per QALY gained (societal), and dominant to $18,000 per QALY gained (healthcare system). Vaccinating high risk adults was highly cost-effective and vaccinating health care workers resulted in $35,000 per QALY gained. Results for healthy working adults were mixed and sensitive to vaccine uptake, efficacy, and productivity loss.</AbstractText><AbstractText Label="CONCLUSIONS">From the societal perspective, vaccination was cost-effective for children, pregnant and postpartum women, high risk groups, and in some cases, healthy working age adults. Immunization programs using group administration are more cost-effective than programs using individual administration. The perspective, programmatic design, setting, and inclusion of herd immunity affects cost-effectiveness. In regions with targeted programs, re-evaluating "high risk" criteria and consideration of a universal program is warranted.</AbstractText><CopyrightInformation>Copyright © 2017 Elsevier Ltd. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Ting</LastName><ForeName>Eon E K</ForeName><Initials>EEK</Initials><AffiliationInfo><Affiliation>Institute of Health Policy, Management & Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada; Program of Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, 11th floor, 686 Bay Street, Toronto, ON M5G 0A4, Canada; AstraZeneca Canada Inc., 1004 Middlegate Road, Mississauga, ON L4Y 1M4, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sander</LastName><ForeName>Beate</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>Institute of Health Policy, Management & Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada; Public Health Ontario, #300 - 480 University Avenue, Toronto, ON M5G 1V2, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ungar</LastName><ForeName>Wendy J</ForeName><Initials>WJ</Initials><AffiliationInfo><Affiliation>Institute of Health Policy, Management & Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada; Program of Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, 11th floor, 686 Bay Street, Toronto, ON M5G 0A4, Canada. Electronic address: wendy.ungar@sickkids.ca.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016454">Review</PublicationType><PublicationType UI="D000078182">Systematic Review</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2017</Year><Month>03</Month><Day>09</Day></ArticleDate></Article><MedlineJournalInfo><Country>Netherlands</Country><MedlineTA>Vaccine</MedlineTA><NlmUniqueID>8406899</NlmUniqueID><ISSNLinking>0264-410X</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D002170" MajorTopicYN="N">Canada</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D003362" MajorTopicYN="Y">Cost-Benefit Analysis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017589" MajorTopicYN="N">Immunization Programs</DescriptorName><QualifierName UI="Q000191" MajorTopicYN="Y">economics</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D007251" MajorTopicYN="N">Influenza, Human</DescriptorName><QualifierName UI="Q000191" MajorTopicYN="Y">economics</QualifierName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName><QualifierName UI="Q000517" MajorTopicYN="Y">prevention & control</QualifierName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="Y">Adults</Keyword><Keyword MajorTopicYN="Y">Children</Keyword><Keyword MajorTopicYN="Y">Cost-effectiveness</Keyword><Keyword MajorTopicYN="Y">High-risk</Keyword><Keyword MajorTopicYN="Y">Influenza immunization</Keyword><Keyword MajorTopicYN="Y">Pregnant women</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2016</Year><Month>09</Month><Day>19</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2017</Year><Month>02</Month><Day>08</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2017</Year><Month>02</Month><Day>20</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2017</Year><Month>3</Month><Day>13</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2017</Year><Month>12</Month><Day>15</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2017</Year><Month>3</Month><Day>13</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">28284681</ArticleId><ArticleId IdType="pii">S0264-410X(17)30247-5</ArticleId><ArticleId IdType="doi">10.1016/j.vaccine.2017.02.044</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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