BACKGROUND The 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. METHODS We 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. RESULTS The 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. CONCLUSIONS Modeling 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.

中文翻译：

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为儿童接种流感疫苗：总体成本效益高，但可能出现不良后果。


背景本研究旨在评估荷兰儿童流感疫苗接种计划的成本效益。这需要评估此类计划对所有年龄段流感负担的长期影响，使用传播模型来解释疫苗有效性的季节性变化以及与自然感染相比疫苗接种后的保护持续时间较短。方法 我们基于随机动态传播模型进行了成本效益分析，该模型已根据荷兰 11 个季节（2003/2004 年至 2014/2015 年）报告的患有流感样疾病的全科医生就诊情况进行校准。我们分析了延长当前计划的成本和影响，即在连续 20 个季节以 50% 的覆盖率对 2-16 岁儿童进行疫苗接种。我们衡量了质量调整生命年 (QALY) 的影响，并采用了社会视角。结果 据估计，儿童疫苗接种计划的平均增量成本效益比 (ICER) 为每获得 QALY 3944 欧元，并且在普通人群中具有成本效益（经过 1000 次模拟；荷兰的传统门槛为每获得 QALY 20,000 欧元）。据估计，儿童疫苗接种计划对于目标群体本身来说并不具有成本效益，每获得 QALY 的平均 ICER 为 57,054 欧元。不确定性分析表明，这些 ICER 隐藏了广泛的结果。尽管引入儿童疫苗接种计划减少了感染数量，但它往往会导致更大的流行病：在 1000 次模拟中，有 23.3% 的儿童疫苗接种计划导致症状发作率大于 5% 的季节增加，这使得预计将对医疗保健系统造成严重压力。 6.在 1000 次模拟中，有 4% 的儿童疫苗接种计划导致 QALY 净损失。这些发现在不同的目标年龄组和疫苗接种覆盖率中都是稳健的。结论 模型表明，在荷兰，儿童流感疫苗接种具有成本效益。然而，如果仅考虑儿童本身的结果，儿童流感疫苗接种并不具有成本效益。在大约四分之一的模拟中，儿童疫苗接种计划的引入增加了症状发作率大于 5% 的季节频率。不能排除整体健康受损的可能性。