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Optimising age coverage of seasonal influenza vaccination in England : a mathematical and health economic evaluation
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Hill, Edward M., Petrou, Stavros, Forster, Henry, de Lusignan, Simon, Yonova, Ivelina and Keeling, Matt J. (2020) Optimising age coverage of seasonal influenza vaccination in England : a mathematical and health economic evaluation. PLoS Computational Biology, 16 (10). e1008278. doi:10.1371/journal.pcbi.1008278 ISSN 1553-7358.
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Official URL: http://dx.doi.org/10.1371/journal.pcbi.1008278
Abstract
For infectious disease prevention, policy-makers are typically required to base policy decisions in light of operational and monetary restrictions, prohibiting implementation of all candidate interventions. To inform the evidence-base underpinning policy decision making, mathematical and health economic modelling can be a valuable constituent.
Applied to England, this study aims to identify the optimal target age groups when extending a seasonal influenza vaccination programme of at-risk individuals to those individuals at low risk of developing complications following infection. To perform this analysis, we utilise an age- and strain-structured transmission model that includes immunity propagation mechanisms which link prior season epidemiological outcomes to immunity at the beginning of the following season. Making use of surveillance data from the past decade in conjunction with our dynamic model, we simulate transmission dynamics of seasonal influenza in England from 2012 to 2018. We infer that modified susceptibility due to natural infection in the previous influenza season is the only immunity propagation mechanism to deliver a non-negligible impact on the transmission dynamics. Further, we discerned case ascertainment to be higher for young infants compared to adults under 65 years old, and uncovered a decrease in case ascertainment as age increased from 65 to 85 years of age.
Our health economic appraisal sweeps vaccination age space to determine threshold vaccine dose prices achieving cost-effectiveness under differing paired strategies. In particular, we model offering vaccination to all those low-risk individuals younger than a given age (but no younger than two years old) and all low-risk individuals older than a given age, while maintaining vaccination of at-risk individuals of any age. All posited strategies were deemed cost-effective. In general, the addition of low-risk vaccination programmes whose coverage encompassed children and young adults (aged 20 and below) were highly cost-effective. The inclusion of elder age-groups to the low-risk programme typically lessened the cost-effectiveness. Notably, elderly-centric programmes vaccinating from 65-75 years and above had the least permitted expense per vaccine.
Item Type: | Journal Article | |||||||||||||||
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Subjects: | R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine |
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Science > Life Sciences (2010- ) Faculty of Science, Engineering and Medicine > Science > Mathematics Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Influenza, Influenza -- Prevention, Influenza -- Prevention -- England -- Mathematical models, Influenza -- Prevention -- England -- Economic aspects , Influenza -- Vaccination -- England -- Mathematical models, Influenza -- Vaccination -- England -- Economic aspects | |||||||||||||||
Journal or Publication Title: | PLoS Computational Biology | |||||||||||||||
Publisher: | Public Library of Science | |||||||||||||||
ISSN: | 1553-7358 | |||||||||||||||
Official Date: | 6 October 2020 | |||||||||||||||
Dates: |
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Volume: | 16 | |||||||||||||||
Number: | 10 | |||||||||||||||
Article Number: | e1008278 | |||||||||||||||
DOI: | 10.1371/journal.pcbi.1008278 | |||||||||||||||
Status: | Peer Reviewed | |||||||||||||||
Publication Status: | Published | |||||||||||||||
Access rights to Published version: | Open Access (Creative Commons) | |||||||||||||||
Date of first compliant deposit: | 23 October 2020 | |||||||||||||||
Date of first compliant Open Access: | 23 October 2020 | |||||||||||||||
RIOXX Funder/Project Grant: |
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