Health and economic impact of seasonal influenza mass vaccination strategies in European settings: a mathematical modelling and cost-effectiveness analysis

Frank G. Sandmann*, Edwin van Leeuwen, Sibylle Bernard-Stoecklin, Itziar Casado, Jesús Castilla, Lisa Domegan, Alin Gherasim, Mariëtte Hooiveld, Irina Kislaya, Amparo Larrauri, Daniel Levy-Bruhl, Ausenda Machado, Diogo F.P. Marques, Iván Martínez-Baz, Clara Mazagatos, Jim McMenamin, Adam Meijer, Josephine L.K. Murray, Baltazar Nunes, Joan O'DonnellArlene Reynolds, Dominic Thorrington, Richard Pebody, Marc Baguelin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)
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Introduction: Despite seasonal influenza vaccination programmes in most countries targeting individuals aged ≥ 65 (or ≥ 55) years and high risk-groups, significant disease burden remains. We explored the impact and cost-effectiveness of 27 vaccination programmes targeting the elderly and/or children in eight European settings (n = 205.8 million). 

Methods: We used an age-structured dynamic-transmission model to infer age- and (sub-)type-specific seasonal influenza virus infections calibrated to England, France, Ireland, Navarra, The Netherlands, Portugal, Scotland, and Spain between 2010/11 and 2017/18. The base-case vaccination scenario consisted of non-adjuvanted, non-high dose trivalent vaccines (TV) and no universal paediatric vaccination. We explored i) moving the elderly to “improved” (i.e., adjuvanted or high-dose) trivalent vaccines (iTV) or non-adjuvanted non-high-dose quadrivalent vaccines (QV); ii) adopting mass paediatric vaccination with TV or QV; and iii) combining the elderly and paediatric strategies. We estimated setting-specific costs and quality-adjusted life years (QALYs) gained from the healthcare perspective, and discounted QALYs at 3.0%. 

Results: In the elderly, the estimated numbers of infection per 100,000 population are reduced by a median of 261.5 (range across settings: 154.4, 475.7) when moving the elderly to iTV and by 150.8 (77.6, 262.3) when moving them to QV. Through indirect protection, adopting mass paediatric programmes with 25% uptake achieves similar reductions in the elderly of 233.6 using TV (range: 58.9, 425.6) or 266.5 using QV (65.7, 477.9), with substantial health gains from averted infections across ages. At €35,000/QALY gained, moving the elderly to iTV plus adopting mass paediatric QV programmes provides the highest mean net benefits and probabilities of being cost-effective in all settings and paediatric coverage levels. 

Conclusion: Given the direct and indirect protection, and depending on the vaccine prices, model results support a combination of having moved the elderly to an improved vaccine and adopting universal paediatric vaccination programmes across the European settings.

Original languageEnglish
Pages (from-to)1306-1315
Number of pages10
Issue number9
Early online date15 Feb 2022
Publication statusPublished - 23 Feb 2022


  • Economic evaluation
  • Influenza
  • Mathematical model
  • Policy
  • Public health
  • Vaccination


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