Cost-effectiveness of introducing national seasonal influenza vaccination for adults aged 60 years and above in mainland China: a modelling analysis

Abstract

Background: China has an aging population with an increasing number of adults aged ≥ 60 years. Influenza causes a heavy disease burden in older adults, but can be alleviated by vaccination. We assessed the cost-effectiveness of a potential government-funded seasonal influenza vaccination program in older adults in China. Methods: We characterized the health and economic impact of a fully funded influenza vaccination program for older adults using China-specific influenza disease burden, and related cost data, etc. Using a decision tree model, we calculated the incremental costs per quality-adjusted life year (QALY) gained of vaccination from the societal perspective, at a willingness-to-pay threshold equivalent to GDP per capita (US$8840). Moreover, we estimated the threshold vaccination costs, under which the fully funded vaccination program is cost-effective using GDP per capita as the willingness-to-pay threshold. Results: Compared to current self-paid vaccination, a fully funded vaccination program is expected to prevent 19, 812 (95% uncertainty interval, 7150-35,783) influenza-like-illness outpatient consultations per year, 9418 (3386-17, 068) severe acute respiratory infection hospitalizations per year, and 8800 (5300-11,667) respiratory excess deaths due to influenza per year, and gain 70,212 (42,106-93,635) QALYs per year. Nationally, the incremental costs per QALY gained of the vaccination program is US$4832 (3460-8307), with a 98% probability of being cost-effective. The threshold vaccination cost is US$10.19 (6.08-13.65). However, variations exist between geographical regions, with Northeast and Central China having lower probabilities of cost-effectiveness. Conclusions: Our results support the implementation of a government fully funded older adult vaccination program in China. The regional analysis provides results across settings that may be relevant to other countries with similar disease burden and economic status, especially for low-and middle-income countries where such analysis is limited.

Influenza-associated disease burden in mainland China: a systematic review and meta-analysis

“…Only a few developed cities such as Beijing have provided free influenza vaccination for older adults using local revenue and have achieved a remarkable increase in local vaccine uptake 56 . In addition, a recent cost-effectiveness study suggests that government fully funded immunization against influenza among older adults proves to be cost-effective for influenza control and prevention in China 57 . Our findings collectively with this evidence inform immunization recommendations in China.…”

Influenza Vaccination for the Prevention of Cardiovascular Disease in the Americas: Consensus document of the Inter-American Society of Cardiology and the Word Heart Federation

“…Over 65 years: In 23 of 25 studies, vaccination was considered cost-effective [ 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 ]. The studies were carried out with economic models in 20 countries (including eight countries in the Americas) and analyzed vaccination with trivalent vaccine, or CE of the use of high-dose trivalent, with adjuvants, or quadrivalent.…”

Willingness to Pay for Seasonal Influenza Vaccination among Children, Chronic Disease Patients, and the Elderly in China: A National Cross-Sectional Survey

“…In Japan, it was found that increasing the subsidy amount by 1000 yen (USD10) led to a one percentage point increase in the vaccination rate among the elderly, thus improving their health outcomes [ 26 ]. In China, a cost-effectiveness study estimated that the threshold vaccination cost is 71.48 yuan (USD10.19) to achieve a fully funded vaccination program for older adults aged ≥60 years [ 27 ]. In the future, combining the financing sources for influenza vaccination (individuals, health insurance, and government) may become a promotive policy signal for individuals to vaccinate against influenza.…”