Eine niederländische Analyse der Influenza-Impfung bei Kindern untersuchte deren Kosteneffektivität hinsichtlich gewonnener oder verlorener Lebensjahre mit guter Lebensqualität (Quality-adjusted life-years).
Bezogen auf die Gesamtbevölkerung (für die Kinder bei der Influenza - anders als bei Covid - als relevanter Teil von Infektketten wirken) ist diese Analyse klar positiv, bezogen auf einen Nutzen der geimpften Kinder selbst ebenso klar negativ.
Zusätzlich fanden die Autoren bei ihren Modellierungen aber das Risiko, dass die Impfung der Kinder zu größeren Grippe-Epidemien führen und damit die Gesamtgesundheit verschlechtern könnte.
Vaccinating children against influenza: overall cost-effective with potential for undesirable outcomes | BMC Medicine | Full Text
The present study aims to assess the cost-effectiveness of an influenza vaccination program for children in the Netherlands. This requires an evaluation of the long-term impact of such a program on the burden of influenza across all age groups, using a transmission model that accounts for the seasonal variability in vaccine effectiveness and the shorter duration of protection following vaccination as compared to natural infection. We performed a cost-effectiveness analysis based on a stochastic dynamic transmission model that has been calibrated to reported GP visits with influenza-like illness in the Netherlands over 11 seasons (2003/2004 to 2014/2015). We analyzed the costs and effects of extending the current program with vaccination of children aged 2–16 years at 50% coverage over 20 consecutive seasons. We measured the effects in quality-adjusted life-years (QALYs) and we adopted a societal perspective. The childhood vaccination program is estimated to have an average incremental cost-effectiveness ratio (ICER) of €3944 per QALY gained and is cost-effective in the general population (across 1000 simulations; conventional Dutch threshold of €20,000 per QALY gained). The childhood vaccination program is not estimated to be cost-effective for the target-group itself with an average ICER of €57,054 per QALY gained. Uncertainty analyses reveal that these ICERs hide a wide range of outcomes. Even though introduction of a childhood vaccination program decreases the number of infections, it tends to lead to larger epidemics: in 23.3% of 1000 simulations, the childhood vaccination program results in an increase in seasons with a symptomatic attack rate larger than 5%, which is expected to cause serious strain on the health care system. In 6.4% of 1000 simulations, the childhood vaccination program leads to a net loss of QALYs. These findings are robust across different targeted age groups and vaccination coverages. Modeling indicates that childhood influenza vaccination is cost-effective in the Netherlands. However, childhood influenza vaccination is not cost-effective when only outcomes for the children themselves are considered. In approximately a quarter of the simulations, the introduction of a childhood vaccination program increases the frequency of seasons with a symptomatic attack rate larger than 5%. The possibility of an overall health loss cannot be excluded.