title: Understanding the cost-effectiveness of influenza vaccination in children: methodological choices and seasonal variability.
abstract: BACKGROUND
  The universal vaccination of children for influenza has recently been recommended in the UK and is being considered in other developed countries.
  
  
  OBJECTIVE
  The aim of this study was to explore the potential costs and benefits of childhood influenza vaccination to gain a better understanding of the key drivers of cost-effectiveness.
  
  
  METHODS
  As our case study we examined the cost-effectiveness of vaccination in Australian schoolchildren using an age-stratified Susceptible Exposed Infectious Recovered model.
  
  
  RESULTS
  The results of this study highlight the critical role that methodological choices play in determining the cost-effectiveness of influenza vaccination. These choices include decisions about the structure of the model (including/excluding herd immunity) and what costs and benefits to include in the analysis. In scenarios where herd protection was included we estimated that the program was likely to be cost-effective. The study also illustrates the importance of the inherent seasonal variability of influenza, which can produce counter-intuitive results, with low transmission seasons being easier to control by vaccination but resulting in fewer benefits.
  
  
  CONCLUSIONS
  Universal childhood influenza vaccination is likely to be cost-effective if a substantial herd protection effect can be achieved by the program. However, it is important that decision makers understand the role of seasonal variability and the impact of alternative methodological choices in economic evaluations of influenza vaccination.
authors: School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia. a.newall@unsw.edu.au
authors: Anthony T
authors: AT
authors: Newall
authors: Juan Pablo
authors: JP
authors: Dehollain
authors: Prudence
authors: P
authors: Creighton
authors: Philippe
authors: P
authors: Beutels
authors: James G
authors: JG
authors: Wood
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D006801:Humans; D007252:Influenza Vaccines / Q000276:immunology*; D019057:Quality-Adjusted Life Years; D012621:Seasons; D014611:Vaccination / Q000191:economics*
chemical_list: D007252:Influenza Vaccines
references: PLoS One. 2011;6(11):e26282
references: 22087226
references: JAMA. 2010 Mar 10;303(10):943-50
references: 20215608
references: Lancet Infect Dis. 2008 Nov;8(11):727-33
references: 18992409
references: Am J Epidemiol. 1985 Jun;121(6):811-22
references: 4014174
references: Med Decis Making. 2003 Jan-Feb;23(1):76-82
references: 12583457
references: Pharmacoeconomics. 2008;26(3):191-215
references: 18282015
references: Vaccine. 2008 Sep 26;26(41):5321-30
references: 18647634
references: Emerg Infect Dis. 2010 Feb;16(2):224-30
references: 20113551
references: Epidemiol Infect. 2008 Jun;136(6):852-64
references: 17634159
references: Med Decis Making. 2011 Jul-Aug;31(4):675-92
references: 21653805
references: Aust N Z J Public Health. 2005 Apr;29(2):136-42
references: 15915617
references: Am J Epidemiol. 1988 Oct;128(4):845-59
references: 3421247
references: Am J Epidemiol. 1992 Aug 1;136(3):328-43
references: 1415152
references: Arch Intern Med. 2002 Sep 9;162(16):1842-8
references: 12196082
references: Am J Epidemiol. 2004 Apr 1;159(7):623-33
references: 15033640
references: Lancet Infect Dis. 2007 Oct;7(10):658-66
references: 17897608
references: Epidemiol Infect. 2010 Jun;138(6):836-42
references: 19941685
references: Lancet Infect Dis. 2008 Aug;8(8):462-3; author reply 463-5
references: 18652991
references: Respir Res. 2008 Jan 24;9:11
references: 18215329
references: Influenza Other Respir Viruses. 2009 Jan;3(1):37-49
references: 19453440
references: BMJ. 2012 Jun 01;344:e3876
references: 22661740
references: Vaccine. 2008 Dec 9;26(52):6818-23
references: 18940222
references: Value Health. 2010 Aug;13(5):519-27
references: 20712601
references: Vaccine. 2012 Aug 24;30(39):5776-81
references: 22789505
references: Pediatrics. 2005 May;115(5):e600-14
references: 15867026
references: Nature. 2006 Jul 27;442(7101):448-52
references: 16642006
references: Science. 2005 Aug 12;309(5737):1083-7
references: 16079251
references: Proc Natl Acad Sci U S A. 2006 Apr 11;103(15):5935-40
references: 16585506
references: Am J Epidemiol. 2009 Sep 15;170(6):679-86
references: 19679750
references: Nature. 2005 Sep 8;437(7056):209-14
references: 16079797
references: Vaccine. 2008 Apr 16;26(17):2135-41
references: 18325639
references: Nature. 2008 Apr 10;452(7188):750-4
references: 18401408
references: Am J Epidemiol. 2008 Apr 1;167(7):775-85
references: 18230677
references: N Engl J Med. 2001 Mar 22;344(12):889-96
references: 11259722
references: Vaccine. 2010 Jun 17;28(27):4416-22
references: 20434543
references: J Health Econ. 1988 Sep;7(3):289-90
references: 10291478
references: PLoS One. 2011 Mar 02;6(3):e17030
references: 21399678
references: Health Econ. 1997 May-Jun;6(3):253-9
references: 9226143
references: PLoS Med. 2008 Mar 25;5(3):e74
references: 18366252
references: Pharmacoeconomics. 2012 Aug 1;30(8):647-60
references: 22788257