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Vaccination against pandemic influenza A/H1N1v in England: a real-time economic evaluation.
Vaccine 2010; 28(12):2370-84V

Abstract

Decisions on how to mitigate an evolving pandemic are technically challenging. We present a real-time assessment of the effectiveness and cost-effectiveness of alternative influenza A/H1N1v vaccination strategies. A transmission dynamic model was fitted to the estimated number of cases in real-time, and used to generate plausible autumn scenarios under different vaccination options. The proportion of these cases by age and risk group leading to primary care consultations, National Pandemic Flu Service consultations, emergency attendances, hospitalisations, intensive care and death was then estimated using existing data from the pandemic. The real-time model suggests that the epidemic will peak in early November, with the peak height being similar in magnitude to the summer wave. Vaccination of the high-risk groups is estimated to prevent about 45 deaths (80% credibility interval 26-67), and save around 2900 QALYs (80% credibility interval 1600-4500). Such a programme is very likely to be cost-effective if the cost of vaccine purchase itself is treated as a sunk cost. Extending vaccination to low-risk individuals is expected to result in more modest gains in deaths and QALYs averted. Extending vaccination to school-age children would be the most cost-effective extension. The early availability of vaccines is crucial in determining the impact of such extensions. There have been a considerable number of cases of H1N1v in England, and so the benefits of vaccination to mitigate the ongoing autumn wave are limited. However, certain groups appear to be at significantly higher risk of complications and deaths, and so it appears both effective and cost-effective to vaccinate them. The United Kingdom was the first country to have a major epidemic in Europe. In countries where the epidemic is not so far advanced vaccination of children may be cost-effective. Similar, detailed, real-time modelling and economic studies could help to clarify the situation.

Authors+Show Affiliations

Centre for Infections, Health Protection Agency, United Kingdom. marc.baguelin@hpa.org.uk <marc.baguelin@hpa.org.uk>No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20096762

Citation

Baguelin, Marc, et al. "Vaccination Against Pandemic Influenza A/H1N1v in England: a Real-time Economic Evaluation." Vaccine, vol. 28, no. 12, 2010, pp. 2370-84.
Baguelin M, Hoek AJ, Jit M, et al. Vaccination against pandemic influenza A/H1N1v in England: a real-time economic evaluation. Vaccine. 2010;28(12):2370-84.
Baguelin, M., Hoek, A. J., Jit, M., Flasche, S., White, P. J., & Edmunds, W. J. (2010). Vaccination against pandemic influenza A/H1N1v in England: a real-time economic evaluation. Vaccine, 28(12), pp. 2370-84. doi:10.1016/j.vaccine.2010.01.002.
Baguelin M, et al. Vaccination Against Pandemic Influenza A/H1N1v in England: a Real-time Economic Evaluation. Vaccine. 2010 Mar 11;28(12):2370-84. PubMed PMID: 20096762.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vaccination against pandemic influenza A/H1N1v in England: a real-time economic evaluation. AU - Baguelin,Marc, AU - Hoek,Albert Jan Van, AU - Jit,Mark, AU - Flasche,Stefan, AU - White,Peter J, AU - Edmunds,W John, Y1 - 2010/01/21/ PY - 2009/11/17/received PY - 2009/12/17/revised PY - 2010/01/06/accepted PY - 2010/1/26/entrez PY - 2010/1/26/pubmed PY - 2010/5/21/medline SP - 2370 EP - 84 JF - Vaccine JO - Vaccine VL - 28 IS - 12 N2 - Decisions on how to mitigate an evolving pandemic are technically challenging. We present a real-time assessment of the effectiveness and cost-effectiveness of alternative influenza A/H1N1v vaccination strategies. A transmission dynamic model was fitted to the estimated number of cases in real-time, and used to generate plausible autumn scenarios under different vaccination options. The proportion of these cases by age and risk group leading to primary care consultations, National Pandemic Flu Service consultations, emergency attendances, hospitalisations, intensive care and death was then estimated using existing data from the pandemic. The real-time model suggests that the epidemic will peak in early November, with the peak height being similar in magnitude to the summer wave. Vaccination of the high-risk groups is estimated to prevent about 45 deaths (80% credibility interval 26-67), and save around 2900 QALYs (80% credibility interval 1600-4500). Such a programme is very likely to be cost-effective if the cost of vaccine purchase itself is treated as a sunk cost. Extending vaccination to low-risk individuals is expected to result in more modest gains in deaths and QALYs averted. Extending vaccination to school-age children would be the most cost-effective extension. The early availability of vaccines is crucial in determining the impact of such extensions. There have been a considerable number of cases of H1N1v in England, and so the benefits of vaccination to mitigate the ongoing autumn wave are limited. However, certain groups appear to be at significantly higher risk of complications and deaths, and so it appears both effective and cost-effective to vaccinate them. The United Kingdom was the first country to have a major epidemic in Europe. In countries where the epidemic is not so far advanced vaccination of children may be cost-effective. Similar, detailed, real-time modelling and economic studies could help to clarify the situation. SN - 1873-2518 UR - https://www.unboundmedicine.com/medline/citation/20096762/Vaccination_against_pandemic_influenza_A/H1N1v_in_England:_a_real_time_economic_evaluation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0264-410X(10)00032-0 DB - PRIME DP - Unbound Medicine ER -