1. Costs and cost-effectiveness of influenza illness and vaccination in low- and middle-income countries: A systematic review from 2012 to 2022.
- Author
-
Gharpure, Radhika, Chard, Anna N., Cabrera Escobar, Maria, Zhou, Weigong, Valleau, Molly M., Yau, Tat S., Bresee, Joseph S., Azziz-Baumgartner, Eduardo, Pallas, Sarah W., and Lafond, Kathryn E.
- Subjects
- *
INFLUENZA vaccines , *MIDDLE-income countries , *ECONOMIC aspects of diseases , *MEDICAL personnel , *COST effectiveness - Abstract
Background: Historically, lack of data on cost-effectiveness of influenza vaccination has been identified as a barrier to vaccine use in low- and middle-income countries. We conducted a systematic review of economic evaluations describing (1) costs of influenza illness; (2) costs of influenza vaccination programs; and (3) vaccination cost-effectiveness from low- and middle-income countries to assess if gaps persist that could hinder global implementation of influenza vaccination programs. Methods and findings: We performed a systematic search in Medline, Embase, Cochrane Library, CINAHL, and Scopus in January 2022 and October 2023 using a combination of the following key words: "influenza" AND "cost" OR "economic." The search included studies with publication years 2012 through 2022. Studies were eligible if they (1) presented original, peer-reviewed findings on cost of illness, cost of vaccination program, or cost-effectiveness of vaccination for seasonal influenza; and (2) included data for at least 1 low- or middle-income country. We abstracted general study characteristics and data specific to each of the 3 study types. Of 54 included studies, 26 presented data on cost-effectiveness, 24 on cost-of-illness, and 5 on program costs. Represented countries were classified as upper-middle income (UMIC; n = 12), lower-middle income (LMIC; n = 7), and low-income (LIC; n = 3). The most evaluated target groups were children (n = 26 studies), older adults (n = 17), and persons with chronic medical conditions (n = 12); fewer studies evaluated pregnant persons (n = 9), healthcare workers (n = 5), and persons in congregate living settings (n = 1). Costs-of-illness were generally higher in UMICs than in LMICs/LICs; however, the highest national economic burden, as a percent of gross domestic product and national health expenditure, was reported from an LIC. Among studies that evaluated the cost-effectiveness of influenza vaccine introduction, most (88%) interpreted at least 1 scenario per target group as either cost-effective or cost-saving, based on thresholds designated in the study. Key limitations of this work included (1) heterogeneity across included studies; (2) restrictiveness of the inclusion criteria used; and (3) potential for missed influenza burden from use of sentinel surveillance systems. Conclusions: The 54 studies identified in this review suggest an increased momentum to generate economic evidence about influenza illness and vaccination from low- and middle-income countries during 2012 to 2022. However, given that we observed substantial heterogeneity, continued evaluation of the economic burden of influenza illness and costs/cost-effectiveness of influenza vaccination, particularly in LICs and among underrepresented target groups (e.g., healthcare workers and pregnant persons), is needed. Use of standardized methodology could facilitate pooling across settings and knowledge sharing to strengthen global influenza vaccination programs. In a systematic review of economic evaluations, Gharpure and team examine the costs of influenza illness and vaccination programs in low- and middle-income countries to assess potential barriers to global implementation. Full length: In this systematic review of economic evaluations, Radhika Gharpure and colleagues examine the costs of influenza illness, the costs of influenza vaccination programs, and the cost-effectiveness of vaccination from low- and middle-income countries to assess whether gaps remain that could hinder global implementation of influenza vaccination programs. Author summary: Why was this study done?: Cost-effectiveness analyses and other economic evaluations can provide important information to guide evidence-based decision-making, resource allocation, and long-term investment in vaccination by demonstrating value-for-money. Cost-effectiveness analyses require accurate input data, including the costs of influenza illness, costs of vaccination, and impact of the vaccination program, to yield relevant and reliable results. What did the researchers do and find?: We conducted a systematic review of studies describing the costs of influenza illness, costs of influenza vaccination programs, and influenza vaccination cost-effectiveness from low- and middle-income country settings during 2012 to 2022, given the availability of updated global tools for economic evaluations. We collated the data from these articles, by study type and vaccination target group, to identify remaining gaps. We identified 54 eligible studies published during 2012 to 2022, representing an increase from prior years, but studies from low-income countries and for specific target groups such as pregnant persons and healthcare workers were limited. What do these findings mean?: Additional studies from low-income countries and underrepresented target groups would strengthen the evidence regarding value-for-money, as robust, global economic data are critical to design and maintain sustainable influenza vaccination programs. Standardization of methodology across future economic evaluations, including considerations to capture the full spectrum of influenza-associated illness, could allow for pooled estimates and meta-analyses. The main limitations of this review were the variability across studies, limiting our ability to generalize and compare findings, as well as restrictiveness of the inclusion criteria and potential for missed influenza burden by sentinel surveillance. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF