Send to

Choose Destination
Appl Health Econ Health Policy. 2017 Apr;15(2):261-276. doi: 10.1007/s40258-016-0296-4.

Assessment of Public Health and Economic Impact of Intranasal Live-Attenuated Influenza Vaccination of Children in France Using a Dynamic Transmission Model.

Author information

QuintilesIMS Real-World Evidence Solutions, Corporate Village, Davos Building, Da Vincilaan 7, 1935, Zaventem, Belgium.
QuintilesIMS Real-World Evidence Solutions, Corporate Village, Davos Building, Da Vincilaan 7, 1935, Zaventem, Belgium.
AstraZeneca, Rueil-Malmaison, France.
Department of Medical Information, University Lille Nord de France, Lille, France.
Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.
Public Health Department, Saint-Antoine Hospital, APHP, Paris, France.
Department of Pediatrics, University Paris VII, Paris, France.
Department of Health Economics and Health Care Management, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany.
ExploSYS GmbH, Leinfelden-Echterdingen, Germany.
Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany.
Epimos GmbH, Dusslingen, Germany.



We estimated the epidemiological and economic impact of extending the French influenza vaccination programme from at-risk/elderly (≥65 years) only to healthy children (2-17 years).


A deterministic, age-structured, dynamic transmission model was used to simulate the transmission of influenza in the French population, using the current vaccination coverage with trivalent inactivated vaccine (TIV) in at-risk/elderly individuals (current strategy) or gradually extending the vaccination to healthy children (aged 2-17 years) with intranasal, quadrivalent live-attenuated influenza vaccine (QLAIV) from current uptake up to 50% (evaluated strategy). Epidemiological, medical resource use and cost data were taken from international literature and country-specific information. The model was calibrated to the observed numbers of influenza-like illness visits/year. The 10-year number of symptomatic cases of confirmed influenza and direct medical costs ('all-payer') were calculated for the 0-17- (direct and indirect effects) and ≥18-year-old (indirect effect). The incremental cost-effectiveness ratio (ICER) was calculated for the total population, using a 4% discount rate/year.


Assuming 2.3 million visits/year and 1960 deaths/year, the model calibration yielded an all-year average basic reproduction number (R 0) of 1.27. In the population aged 0-17 years, QLAIV prevented 865,000 influenza cases/year (58.4%), preventing 10-year direct medical expenses of €374 million. In those aged ≥18 years with unchanged TIV coverage, 1.2 million cases/year were averted (27.6%) via indirect effects (additionally prevented expenses, €457 million). On average, 613 influenza-related deaths were averted annually overall. The ICER was €18,001/life-year gained. The evaluated strategy had a 98% probability of being cost-effective at a €31,000/life-year gained threshold.


The model demonstrated strong direct and indirect benefits of protecting healthy children against influenza with QLAIV on public health and economic outcomes in France.

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center