Cost-effectiveness of seasonal influenza vaccination of children in China: a modeling analysis

Infect Dis Poverty. 2023 Oct 11;12(1):92. doi: 10.1186/s40249-023-01144-6.

Abstract

Background: China has a high burden of influenza-associated illness among children. We aimed to evaluate the cost-effectiveness of introducing government-funded influenza vaccination to children in China (fully-funded policy) compared with the status quo (self-paid policy).

Methods: A decision tree model was developed to calculate the economic and health outcomes, from a societal perspective, using national- and provincial-level data. The incremental cost-effectiveness ratio (ICER) [incremental costs per quality-adjusted life year (QALY) gained] was used to compare the fully-funded policy with the self-paid policy under the willingness-to-pay threshold equivalent to national and provincial GDP per capita. Sensitivity analyses were performed and various scenarios were explored based on real-world conditions, including incorporating indirect effect into the analysis.

Results: Compared to the self-paid policy, implementation of a fully-funded policy could prevent 1,444,768 [95% uncertainty range (UR): 1,203,446-1,719,761] symptomatic cases, 92,110 (95% UR: 66,953-122,226) influenza-related hospitalizations, and 6494 (95% UR: 4590-8962) influenza-related death per season. The fully-funded policy was cost-effective nationally (7964 USD per QALY gained) and provincially for 13 of 31 provincial-level administrative divisions (PLADs). The probability of a funded vaccination policy being cost-effective was 56.5% nationally, and the probability in 9 of 31 PLADs was above 75%. The result was most sensitive to the symptomatic influenza rate among children under 5 years [ICER ranging from - 25,612 (cost-saving) to 14,532 USD per QALY gained]. The ICER of the fully-funded policy was substantially lower (becoming cost-saving) if the indirect effects of vaccination were considered.

Conclusions: Introducing a government-funded influenza policy for children is cost-effective in China nationally and in many PLADs. PLADs with high symptomatic influenza rate and influenza-associated mortality would benefit the most from a government-funded influenza vaccination program.

Keywords: Children; China; Cost-effectiveness analysis; Influenza; Vaccination.

Publication types

  • Comparative Study

MeSH terms

  • Child
  • Child, Preschool
  • China / epidemiology
  • Cost-Benefit Analysis
  • Financing, Government / economics
  • Humans
  • Influenza Vaccines* / economics
  • Influenza Vaccines* / therapeutic use
  • Influenza, Human* / economics
  • Influenza, Human* / epidemiology
  • Influenza, Human* / prevention & control
  • Quality-Adjusted Life Years
  • Seasons
  • Vaccination* / economics
  • Vaccination* / methods
  • Vaccination* / statistics & numerical data

Substances

  • Influenza Vaccines