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      Coste-efectividad de la vacunación contra la gripe estacional para diferentes grupos de edad: Una revisión sistemática Translated title: Cost-effectiveness of vaccines for the prevention of seasonal influenza in different age groups: a systematic review

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          RESUMEN

          Fundamentos:

          Dada la carga económica que supone para el sistema sanitario la gripe estacional, se plantea esta revisión sistemática cuyo objetivo fue actualizar la evidencia disponible sobre el coste-efectividad de vacunación contra la gripe estacional en diferentes grupos de edad, incluyendo población infantil.

          Métodos:

          Se llevó a cabo una revisión sistemática de la literatura de evaluaciones económicas de los programas de vacunación contra la gripe estacional en niños y adultos. Se realizaron búsquedas en las bases de datos (enero 2013 - abril 2018): Medline y PREMEDLINE, EMBASE, EconLit y en las bases de datos del Centre for Reviews and Dissemination (DARE, HTA, NHS EED).

          Resultados:

          Se incluyeron 11 evaluaciones económicas. La calidad metodológica de los estudios incluidos fue buena. La evidencia científica muestra que los programas de vacunación contra la gripe estacional en niños en edad escolar pueden ser una estrategia coste-efectiva desde la perspectiva sanitaria en países europeos. La evidencia científica disponible hasta el momento no nos permite concluir que los programas de vacunación antigripal en adultos sanos de menos de 65 años de edad sean una alternativa coste-efectiva en nuestro contexto, debido a la elevada incertidumbre existente y a la escasez de estudios realizados en el contexto español.

          Conclusiones:

          Los programas de vacunación contra la gripe estacional en niños en edad escolar (3-16 años) pueden ser una estrategia coste-efectiva desde la perspectiva del SNS.

          ABSTRACT

          Background:

          Given the economic burden of seasonal influenza for the healthcare system, we performed a systematic review aiming to update available evidence on the cost-effectiveness of vaccination of seasonal influenza in different age groups, including children.

          Methods:

          A systematic review of the literature on economic evaluations of seasonal influenza vaccination programs in children and adults was carried out. The following databases were searched (January 2013 - April 2018): Medline and PREMEDLINE, EMBASE, EconLit and databases of the Centre for Reviews and Dissemination (DARE, HTA, NHS EED).

          Results:

          A total of 11 economic evaluations were included. Methodological quality of included studies was acceptable. Scientific evidence shows that seasonal influenza vaccination programs in school-age children can be a cost-effective alternative from national health system perspective and can be cost-saving from societal perspective in European countries. However, available evidence does not allow us to conclude that influenza vaccination programs in healthy adults under 65 years of age were a cost-effective alternative in our context, due to the high uncertainty and the lack of studies carried out in Spanish context.

          Conclusions:

          Vaccination programs for the prevention of seasonal influenza in school-age children (3-16 years) can be a cost-effective strategy.

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          Most cited references30

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          Estimating a cost-effectiveness threshold for the Spanish NHS

          The cost of generating a quality-adjusted life year (QALY) within a National Health Service provides an approximation of the average opportunity cost of funding decisions. This information can be used to inform a cost-effectiveness threshold. The aim of this paper is to estimate the cost per QALY at the Spanish National Health Service. We exploit variation across 17 regional health services and the exogenous changes in expenditure that took place as a consequence of the economic crisis over 5 years of data. We conduct fixed effect models and use an instrumental variable approach to test for potential remaining endogeneity. Our results show that health expenditure has a positive and significant effect on population health, with an average spending elasticity of 0.07. This translates into a cost per QALY of between 22,000€ and 25,000€. These values are below the cost-effectiveness threshold figure of 30,000€ commonly cited in Spain.
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            Influenza cost and cost-effectiveness studies globally--a review.

            Every year, approximately 10-20% of the world's population is infected with influenza viruses, resulting in a significant number of outpatient and hospital visits and substantial economic burden both on health care systems and society. With recently updated WHO recommendations on influenza vaccination and broadening vaccine production, policy makers in middle- and low-income countries will need data on the cost of influenza disease and the cost effectiveness of vaccination. We reviewed the published literature to summarize estimates of cost and cost-effectiveness of influenza vaccination. We searched PUBMED (MEDLINE), EMBASE, WEB of KNOWLEDGE, and IGOOGLE using the key words 'influenza', 'economic cost', 'cost effectiveness', and 'economic burden'. We identified 140 studies which estimated either cost associated with seasonal influenza or cost effectiveness/cost-benefit of influenza vaccination. 118 of these studies were conducted in World Bank-defined high income, 22 in upper-middle income, and no studies in low and lower-middle income countries. The per capita cost of a case of influenza illness ranged from $30 to $64. 22 studies reported that influenza vaccination was cost-saving; reported cost-effectiveness ratios were $10,000/outcome in 13 studies, $10,000 to $50,000 in 13 studies, and ≥$50,000 in 3 studies. There were no studies from low income countries and few studies among pregnant women. Substantial differences in methodology limited the generalization of results. Decision makers in lower income countries lack economic data to support influenza vaccine policy decisions, especially of pregnant women. Standardized cost-effectiveness studies of influenza vaccination of WHO-recommended risk groups' methods are urgently needed. Copyright © 2013 Elsevier Ltd. All rights reserved.
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              Prevention and control of seasonal influenza with vaccines. Recommendations of the Advisory Committee on Immunization Practices--United States, 2013-2014.

              David Shay (2013)
              This report updates the 2012 recommendations by CDC's Advisory Committee on Immunization Practices (ACIP) regarding the use of influenza vaccines for the prevention and control of seasonal influenza (CDC. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2012;61:613-8). Routine annual influenza vaccination is recommended for all persons aged ≥ 6 months. For the 2013-14 influenza season, it is expected that trivalent live attenuated influenza vaccine (LAIV3) will be replaced by a quadrivalent LAIV formulation (LAIV4). Inactivated influenza vaccines (IIVs) will be available in both trivalent (IIV3) and quadrivalent (IIV4) formulations. Vaccine virus strains included in the 2013-14 U.S. trivalent influenza vaccines will be an A/California/7/2009 (H1N1)-like virus, an H3N2 virus antigenically like the cell-propagated prototype virus A/Victoria/361/2011, and a B/Massachusetts/2/2012-like virus. Quadrivalent vaccines will include an additional influenza B virus strain, a B/Brisbane/60/2008-like virus, intended to ensure that both influenza B virus antigenic lineages (Victoria and Yamagata) are included in the vaccine. This report describes recently approved vaccines, including LAIV4, IIV4, trivalent cell culture-based inactivated influenza vaccine (ccIIV3), and trivalent recombinant influenza vaccine (RIV3). No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one product is otherwise appropriate. This information is intended for vaccination providers, immunization program personnel, and public health personnel. These recommendations and other information are available at CDC's influenza website (http://www.cdc.gov/flu); any updates also will be found at this website. Vaccination and health-care providers should check the CDC influenza website periodically for additional information.
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                Author and article information

                Journal
                Rev Esp Salud Publica
                Rev Esp Salud Publica
                resp
                Revista Española de Salud Pública
                Ministerio de Sanidad, Consumo y Bienestar social
                1135-5727
                2173-9110
                17 October 2018
                Jan-Dec 2018
                : 92
                : e201810075
                Affiliations
                [1 ] originalFundación Canaria de Investigación Sanitaria (FUNCANIS). Santa Cruz de Tenerife. España. orgnameFundación Canaria de Investigación Sanitaria (FUNCANIS) Santa Cruz de Tenerife España
                [2 ] originalRed de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC). Madrid. España. orgnameRed de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) Madrid España
                [3 ] originalCentro de Investigaciones Biomédicas de Canarias (CIBICAN). Universidad de La Laguna. Santa Cruz de Tenerife. España. orgdiv1Centro de Investigaciones Biomédicas de Canarias (CIBICAN) orgnameUniversidad de La Laguna Santa Cruz de Tenerife España
                [4 ] originalDepartamento de Psicología Clínica, Psicobiología y Metodología. Universidad de La Laguna. Santa Cruz de Tenerife. España. orgdiv1Departamento de Psicología Clínica, Psicobiología y Metodología orgnameUniversidad de La Laguna Santa Cruz de Tenerife España
                [5 ] originalAgencia de Evaluación de Tecnologías Sanitarias. Instituto de Salud Carlos III. Madrid. España. orgdiv1Agencia de Evaluación de Tecnologías Sanitarias orgnameInstituto de Salud Carlos III Madrid España
                [6 ] originalServicio de Evaluación de la Dirección del Servicio Canario de la Salud (SESCS). Santa Cruz de Tenerife. España. orgnameServicio de Evaluación de la Dirección del Servicio Canario de la Salud (SESCS) Santa Cruz de Tenerife España
                Author notes
                Correspondencia: Cristina Valcárcel Nazco Servicio de Evaluación y Planificación Servicio Canario de la Salud Camino Candelaria, 44. C.S San Isidro-El Chorrillo. 38109 El Rosario, Tenerife, España cristina.valcarcelnazco@ 123456sescs.es

                Los autores del presente estudio declaran no tener conflicto de intereses.

                Article
                e201810075
                11587293
                30327454
                5a1fba3f-fe34-475b-9eab-e3ad8cc9c70b

                This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. You are free to Share (copy and redistribute the material in any medium or format) under the following terms: Attribution (You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use); NonCommercial (You may not use the material for commercial purposes); NoDerivatives (If you remix, transform, or build upon the material, you may not distribute the modified material); No additional restrictions (You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits).

                History
                : 24 May 2017
                : 03 October 2018
                : 17 October 2018
                Page count
                Figures: 1, Tables: 4, Equations: 0, References: 30, Pages: 1
                Categories
                Revisiones

                gripe,vacuna de la gripe,coste-efectividad,españa,revisión sistemática,influenza,influenza vaccine,cost-effectiveness,spain,systematic review

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