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Background: Seasonal influenza epidemics have a substantial public health and economic burden, which can be alleviated through vaccination. The World Health Organization (WHO) recommends a 75% vaccination coverage rate (VCR) in: older adults (aged ≥ 65 years), individuals with chronic conditions, pregnant women, children aged 6-24 months and healthcare workers. However, no European country achieves this target in all risk groups. In this study, potential public health and economic benefits achieved by reaching 75% influenza VCR was estimated in risk groups across four European countries: France, Italy, Spain, and the UK., Methods: A static epidemiological model was used to estimate the averted public health and economic burden of increasing the 2021/2022 season VCR to 75%, using the efficacy data of standard-dose quadrivalent influenza vaccine. For each country and risk group, the most recent data on population size, VCR, pre-pandemic influenza epidemiology, direct medical costs and absenteeism were identified through a systematic literature review, supplemented by manual searching. Outcomes were: averted influenza cases, general practitioner (GP) visits, hospitalisations, case fatalities, number of days of work lost, direct medical costs and absenteeism-related costs., Results: As of the 2021/2022 season, the UK achieved the highest weighted VCR across risk groups (65%), followed by Spain (47%), France (44%) and Italy (44%). Based on modelling, the 2021/2022 VCR prevented an estimated 1.9 million influenza cases, avoiding 375,200 GP visits, 73,200 hospitalisations and 38,400 deaths. To achieve the WHO 75% VCR target, an additional 24 million at-risk individuals would need to be vaccinated, most of which being older adults and patients with chronic conditions. It was estimated that this could avoid a further 918,200 influenza cases, 332,000 GP visits, 16,300 hospitalisations and 6,300 deaths across the four countries, with older adults accounting for 52% of hospitalisations and 80% of deaths. An additional €84 million in direct medical costs and €79 million in absenteeism costs would be saved in total, with most economic benefits delivered in France., Conclusions: Older adults represent most vaccine-preventable influenza cases and deaths, followed by individuals with chronic conditions. Health authorities should prioritise vaccinating these populations for maximum public health and economic benefits., (© 2024. The Author(s).)

Objectives: Annually in France, influenza results in over one million GP consultations, around 20,000 hospitalizations, and approximately 9,000 deaths. This study assesses the cost-effectiveness of cell-based quadrivalent influenza vaccine (QIVc) for those under 65, which enhances effectiveness avoiding egg-adaptation, compared to egg-based quadrivalent influenza vaccine (QIVe)., Methods: An age-structured susceptible-exposed-infected-recovered (SEIR) transmission model, calibrated to represent an average influenza season based on French data from 2011 to 2019, integrates a contact matrix estimating intergroup contact rates. Evaluating epidemiological, economic and utility outcomes, the model includes vaccine effectiveness and medical costs from the existing literature and French national data. Adjustments to quality of life due to infection and hospitalization are also included. Uncertainty is explored through scenario and sensitivity analyses., Results: Compared to QIVe, QIVc significantly reduces healthcare utilization and mortality, preventing 49,946 GP consultations, 1,087 hospitalizations, and 231 deaths in France. Despite an initial investment of 7.6 million euros, QIVc achieves a net saving of 12 million euros in healthcare expenditures, making it a dominant cost-saving strategy. Probabilistic sensitivity analyses indicate dominance in 78% of 10,000 simulations., Conclusions: Introducing cell-based influenza vaccines in the French immunization program prevents influenza cases, hospitalizations, death, while reducing costs versus egg-based influenza vaccines.

Background: Seasonal influenza outbreaks in France cause a surge in patients, exacerbating the overburdened healthcare system each winter. Older adults are particularly vulnerable to serious events related to influenza. Quadrivalent influenza high dose (QIV HD) vaccines have been developed to offer better clinical protection in older adults, who often exhibit suboptimal immune response to quadrivalent influenza standard dose vaccines (QIV SD). This study aims to evaluate the public health impact and cost-effectiveness of administering HD versus SD vaccines to individuals aged 65+ in France., Methodology: Using a static model and decision-tree approach, the study analyzed health outcomes such as influenza cases, GP (general practitioner) visits, hospitalizations, and mortality; relative vaccine efficacy (rVE) estimates were derived from a pivotal randomized-controlled trial and a meta-analysis comparing HD to SD vaccines. Two approaches were implemented to model hospitalizations (conditional on influenza or not), and analyses on bed occupancy were performed., Results: Results showed that using QIV HD instead of QIV SD during an average influenza season in France led to the prevention of 57,209 additional cases of influenza, 13,704 GP visits, and 764 influenza-related deaths. Moreover, switching to QIV HD resulted in an additional 1,728-15,970 hospitalizations avoided and 15,124-138,367 reduced days of hospitalization depending on the hospitalization approach used. The cost-utility analysis showed a cost per quality-adjusted life year (QALY) gained ranging from 24,020 €/QALY to 5,036 €/QALY., Conclusions: Switching to QIV HD in older adults was shown to be cost-effective, with even greater public health benefits at a higher coverage rate, regardless of the season severity.

Introduction: The French general health insurance scheme has implemented a national influenza vaccination program including full refund for those 65 years old or more and those under 65 years of age with a targeted chronic disease., Objectives: Our aim was to evaluate vaccination coverage (VC) according to sex, age, targeted chronic disease and geographical regions., Methods: Data on vaccination refund for patients covered by the general health insurance scheme (85% of French population) was collected from the refund information system for the 2007-2008 campaign., Results: Among the 11,618,719 targeted individuals, the overall VC was 51.5% (9.6% for individuals <10 years of age, 15.0% between 10 and 19, 28.1% between 20 and 64, and 63.3% for 65 individuals years of age or more). For those under 20 years of age, VC rates were inferior to 35% for targeted groups except for cystic fibrosis (67%). Among individuals 65 years of age or more, VC was 63.3%. The VC was 74.1% for people 65 years old or more with at least five refunds 6-months before vaccination (80% of the group) and for the others it was under 30%. The frequency of refund, vaccination for the 2006/2007 campaign, and having an attending physician were associated with an increased VC., Conclusion: Refund data is useful to determine and understand VC among target groups, to build specific strategies among those groups and to assess their impact. VC could be underestimated because some target individuals may be vaccinated through non-refundable procedures. Specific studies should improve the understanding of vaccination attitudes in targeted groups.

Objective: The aim of this study was to compare the cost of vaccination for the Clermont-Ferrand University hospital (CHU) personnel and the cost of sick leave among vaccinated and non-vaccinated employees in 2003, 2004, and 2005., Design: The study included 7256 CHU staff (medical and non-medical personnel). The cost of sick leave was calculated on the basis of short-term disease (four to nine days) over the three months of the epidemic season in 2004, 2005, and 2006., Results: In 2005, the overall cost of vaccination was 4.02 euros per vaccinated employee. Over the three years, the total sick leave reached 804 days for employees vaccinated against 5670 for non-vaccinated employees. In 2003, 2004, and 2005, the vaccinal coverage was 13, 20.5, and 30.1%, the mean duration of sick leave was 0.16, 0.17, and 0.18 day among vaccinated staff, and 0.26, 0.39, and 0.34 day among non-vaccinated staff corresponding to a benefit per vaccinated employee of 5, 26, and 20 euros, respectively for each year. The total benefit for the institution was 86,458 euros (4630+38,168+43,660). If the vaccinated rate of 75% recommended by the Haute Autorité de santé (HAS) had been reached, the additional benefit would have been 250,193 euros (33,157+152,256+65,180)., Conclusions: The number of sick leave days and the related cost were approximately twice less important for vaccinated employees, economically justifying this vaccination including a period of weak epidemic, as checked over three consecutive years.

Objectives: Routine influenza vaccination is currently recommended in several countries for people aged more than 60 or 65 years or with high risk of complications. A lower age threshold of 50 years has been recommended in the United States since 1999. To help policymakers consider whether such a policy should be adopted more widely, we conducted an economic evaluation of lowering the age limit for routine influenza vaccination to 50 years in Brazil, France, Germany, and Italy., Methods: The probabilistic model was designed to compare in a single season the costs and clinical outcomes associated with two alternative vaccination policies for persons aged 50 to 64 years: reimbursement only for people at high risk of complications (current policy), and reimbursement for all individuals in this age group (proposed policy). Two perspectives were considered: third-party payer (TPP) and societal. Model inputs were obtained primarily from the published literature and validated through expert opinion. The historical distribution of annual influenza-like illness (ILI) incidence was used to simulate the uncertain incidence in any given season. We estimated gains in unadjusted and quality-adjusted life expectancy, and the cost per quality-adjusted life-year (QALY) gained. Deterministic and probabilistic sensitivity analyses were conducted., Results: Comparing the proposed to the current policy, the estimated mean costs per QALY gained were R$4,100, EURO 13,200, EURO 31,400 and EURO 15,700 for Brazil, France, Germany, and Italy, respectively, from a TPP perspective. From the societal perspective, the age-based policy is predicted to yield net cost savings in Germany and Italy, whereas the cost per QALY decreased to R$2800 for Brazil and EURO 8000 for France. The results were particularly sensitive to the ILI incidence rate, vaccine uptake, influenza fatality rate, and the costs of administering vaccination. Assuming a cost-effectiveness threshold ratio of EURO 50,000 per QALY gained, the probabilities of the new policy being cost-effective were 94% and 95% for France, 72% and near 100% for Germany, and 89% and 99% for Italy, from the TPP and societal perspectives, respectively., Conclusions: Extending routine influenza vaccination to people more than 50 years of age is likely to be cost-effective in all four countries studied.

The cost-of-illness studies of influenza performed in France or the years 1985 and 1989 have shown that the major economic consideration in the respective sizes of indirect and direct costs. Depending on the point of view (from the perspective of National Health Insurance or the societal perspective) and the method used for measuring indirect costs, it was estimated that they could be between 1.5 and 9 times higher than direct costs. A cost-benefit study of influenza vaccination for the employed adult population showed that vaccination is a cost-saving strategy, although this was also contingent upon the problems associated with measuring indirect benefits as well as the effectiveness rate of vaccination in real conditions.