title: Influenza vaccines in low and middle income countries: a systematic review of economic evaluations.
abstract: OBJECTIVE
  Economic evaluations on influenza vaccination from low resource settings are scarce and have not been evaluated using a systematic approach. Our objective was to conduct a systematic review on the value for money of influenza vaccination in low- and middle-income countries.
  
  
  METHODS
  PubMed and EMBASE were searched for economic evaluations published in any language between 1960 and 2011. Main outcome measures were costs per influenza outcome averted, costs per quality-adjusted life years gained or disability-adjusted life years averted, costs per benefit in monetary units or cost-benefit ratios.
  
  
  RESULTS
  Nine economic evaluations on seasonal influenza vaccine met the inclusion criteria. These were model- or randomized-controlled-trial (RCT)-based economic evaluations from middle-income countries. Influenza vaccination provided value for money for elderly, infants, adults and children with high-risk conditions. Vaccination was cost-effective and cost-saving for chronic obstructive pulmonary disease patients and in elderly above 65 y from model-based evaluations, but conclusions from RCTs on elderly varied.
  
  
  CONCLUSIONS
  Economic evaluations from middle income regions differed in population studied, outcomes and definitions used. Most findings are in line with evidence from high-income countries highlighting that influenza vaccine is likely to provide value for money. However, serious methodological limitations do not allow drawing conclusions on cost-effectiveness of influenza vaccination in middle income countries. Evidence on cost-effectiveness from low-income countries is lacking altogether, and more information is needed from full economic evaluations that are conducted in a standardized manner.
authors.affiliation: World Health Organization; Initiative for Vaccine Research; Geneva, Switzerland; Helmholtz Centre for Infection Research; Department of Epidemiology; Braunschweig, Germany.
authors.forename: Jördis J
authors.initials: JJ
authors.lastname: Ott
authors.forename: Janna
authors.initials: J
authors.lastname: Klein Breteler
authors.forename: John S
authors.initials: JS
authors.lastname: Tam
authors.forename: Raymond C W
authors.initials: RC
authors.lastname: Hutubessy
authors.forename: Mark
authors.initials: M
authors.lastname: Jit
authors.forename: Michiel R
authors.initials: MR
authors.lastname: de Boer
mesh_terms: D003362:Cost-Benefit Analysis / Q000191:economics*; D019049:Developed Countries / Q000191:economics; D003906:Developing Countries / Q000191:economics*; D006801:Humans; D007252:Influenza Vaccines / Q000191:economics*; D007251:Influenza, Human / Q000191:economics* / Q000517:prevention & control; D017063:Outcome Assessment, Health Care / Q000191:economics; D058873:Pandemics / Q000191:economics; D019057:Quality-Adjusted Life Years; D014611:Vaccination / Q000191:economics
chemical_list: D007252:Influenza Vaccines
keywords: cost analysis; developing countries; economic evaluation; influenza; systematic review; vaccines