title: Assessment of Public Health and Economic Impact of Intranasal Live-Attenuated Influenza Vaccination of Children in France Using a Dynamic Transmission Model.
abstract: OBJECTIVE
  We estimated the epidemiological and economic impact of extending the French influenza vaccination programme from at-risk/elderly (≥65 years) only to healthy children (2-17 years).
  
  
  METHODS
  A deterministic, age-structured, dynamic transmission model was used to simulate the transmission of influenza in the French population, using the current vaccination coverage with trivalent inactivated vaccine (TIV) in at-risk/elderly individuals (current strategy) or gradually extending the vaccination to healthy children (aged 2-17 years) with intranasal, quadrivalent live-attenuated influenza vaccine (QLAIV) from current uptake up to 50% (evaluated strategy). Epidemiological, medical resource use and cost data were taken from international literature and country-specific information. The model was calibrated to the observed numbers of influenza-like illness visits/year. The 10-year number of symptomatic cases of confirmed influenza and direct medical costs ('all-payer') were calculated for the 0-17- (direct and indirect effects) and ≥18-year-old (indirect effect). The incremental cost-effectiveness ratio (ICER) was calculated for the total population, using a 4% discount rate/year.
  
  
  RESULTS
  Assuming 2.3 million visits/year and 1960 deaths/year, the model calibration yielded an all-year average basic reproduction number (R0) of 1.27. In the population aged 0-17 years, QLAIV prevented 865,000 influenza cases/year (58.4%), preventing 10-year direct medical expenses of €374 million. In those aged ≥18 years with unchanged TIV coverage, 1.2 million cases/year were averted (27.6%) via indirect effects (additionally prevented expenses, €457 million). On average, 613 influenza-related deaths were averted annually overall. The ICER was €18,001/life-year gained. The evaluated strategy had a 98% probability of being cost-effective at a €31,000/life-year gained threshold.
  
  
  CONCLUSIONS
  The model demonstrated strong direct and indirect benefits of protecting healthy children against influenza with QLAIV on public health and economic outcomes in France.
authors.affiliation: QuintilesIMS Real-World Evidence Solutions, Corporate Village, Davos Building, Da Vincilaan 7, 1935, Zaventem, Belgium. Laetitia.Gerlier@quintilesims.com.
authors.forename: L
authors.initials: L
authors.lastname: Gerlier
authors.affiliation: QuintilesIMS Real-World Evidence Solutions, Corporate Village, Davos Building, Da Vincilaan 7, 1935, Zaventem, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Lamotte
authors.affiliation: AstraZeneca, Rueil-Malmaison, France.
authors.forename: S
authors.initials: S
authors.lastname: Grenèche
authors.affiliation: Department of Medical Information, University Lille Nord de France, Lille, France.
authors.forename: X
authors.initials: X
authors.lastname: Lenne
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.|Public Health Department, Saint-Antoine Hospital, APHP, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Carrat
authors.affiliation: Department of Pediatrics, University Paris VII, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Weil-Olivier
authors.affiliation: Department of Health Economics and Health Care Management, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Damm
authors.affiliation: ExploSYS GmbH, Leinfelden-Echterdingen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schwehm
authors.affiliation: Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany.|Epimos GmbH, Dusslingen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Eichner
mesh_terms: D000281:Administration, Intranasal; D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005602:France / Q000453:epidemiology; D006801:Humans; D007252:Influenza Vaccines / Q000191:economics / Q000627:therapeutic use*; D007251:Influenza, Human / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D015233:Models, Statistical; D014613:Vaccines, Attenuated / Q000191:economics / Q000627:therapeutic use
chemical_list: D007252:Influenza Vaccines; D014613:Vaccines, Attenuated