title: Cost-effectiveness analysis of the direct and indirect impact of intranasal live attenuated influenza vaccination strategies in children: alternative country profiles.
abstract: BACKGROUND
  Influenza poses a significant burden on healthcare systems and society, with under-recognition in the paediatric population. Existing vaccination policies (largely) target the elderly and other risk groups where complications may arise.
  
  
  OBJECTIVE
  The goal of this study was to evaluate the cost-effectiveness of annual paediatric vaccination (in 2-17-year-olds) with live attenuated influenza vaccination (LAIV), as well as the protective effect on the wider population in England and Wales (base). The study aimed to demonstrate broad applications of the model in countries where epidemiological and transmission data is limited and that have sophisticated vaccination policies (Brazil, Spain, and Taiwan).
  
  
  METHODS
  The direct and indirect impact of LAIV in the paediatric cohort was simulated using an age-stratified dynamic transmission model over a 5-year time horizon of daily cycles and applying discounting of 3.5% in the base case. Pre-existing immunity structure was based on a 1-year model run. Sensitivity analyses were conducted.
  
  
  RESULTS
  In the base case for England and Wales, the annual paediatric strategy with LAIV was associated with improvements in influenza-related events and quality-adjusted life years (QALYs) lost, yielding an incremental cost per QALY of £6,208. The model was robust to change in the key input parameters. The probabilistic analysis demonstrated LAIV to be cost effective in more than 99% of iterations, assuming a willingness-to-pay threshold of £30,000. Incremental costs per QALY for Brazil were £2,817, and for the cases of Spain and Taiwan the proposed strategy was dominant over the current practice.
  
  
  CONCLUSIONS
  In addition to existing policies, annual paediatric vaccination using LAIV provides a cost-effective strategy that offers direct and indirect protection in the wider community. Paediatric vaccination strategies using LAIV demonstrated clinical and economic benefits over alternative (current vaccination) strategies in England and Wales as well as Brazil, Spain, and Taiwan.
authors.affiliation: Wickenstones, Oxford, UK.
authors.forename: Edward
authors.initials: E
authors.lastname: Gibson
authors.affiliation: Wickenstones, Oxford, UK.
authors.forename: Najida
authors.initials: N
authors.lastname: Begum
authors.affiliation: Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
authors.forename: Federico
authors.initials: F
authors.lastname: Martinón-Torres
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil.
authors.forename: Marco Aurélio
authors.initials: MA
authors.lastname: Safadi
authors.affiliation: AstraZeneca, Cambridge, UK.
authors.forename: Alfred
authors.initials: A
authors.lastname: Sackeyfio
authors.affiliation: AstraZeneca, Gaithersburg, MD, USA.
authors.forename: Judith
authors.initials: J
authors.lastname: Hackett
authors.affiliation: AstraZeneca, London, UK.
authors.forename: Sankarasubramanian
authors.initials: S
authors.lastname: Rajaram
keywords: LAIV; alternative country profiles; cost-effectiveness; dynamic transmission model; herd immunity; influenza; paediatric