Health and economic impact of seasonal influenza mass vaccination strategies in European settings: A mathematical modelling and cost-effectiveness analysis

Frank G. Sandmann*, Edwin van Leeuwen, Sibylle Bernard-Stoecklin, Itziar Casado, Jesús Castilla, Lisa Domegan, Alin Gherasim, Mariëtte Hooiveld, Irina Kislaya, Amparo Larrauri, Daniel Levy-Bruhl, Ausenda Machado, Diogo F.P. Marques, Iván Martínez-Baz, Clara Mazagatos, Jim McMenamin, Adam Meijer, Josephine L.K. Murray, Baltazar Nunes, Joan O'DonnellArlene Reynolds, Dominic Thorrington, Richard Pebody, Marc Baguelin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)
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Introduction: Despite seasonal influenza vaccination programmes in most countries targeting individuals aged ≥ 65 (or ≥ 55) years and high risk-groups, significant disease burden remains. We explored the impact and cost-effectiveness of 27 vaccination programmes targeting the elderly and/or children in eight European settings (n = 205.8 million). 

Methods: We used an age-structured dynamic-transmission model to infer age- and (sub-)type-specific seasonal influenza virus infections calibrated to England, France, Ireland, Navarra, The Netherlands, Portugal, Scotland, and Spain between 2010/11 and 2017/18. The base-case vaccination scenario consisted of non-adjuvanted, non-high dose trivalent vaccines (TV) and no universal paediatric vaccination. We explored i) moving the elderly to “improved” (i.e., adjuvanted or high-dose) trivalent vaccines (iTV) or non-adjuvanted non-high-dose quadrivalent vaccines (QV); ii) adopting mass paediatric vaccination with TV or QV; and iii) combining the elderly and paediatric strategies. We estimated setting-specific costs and quality-adjusted life years (QALYs) gained from the healthcare perspective, and discounted QALYs at 3.0%. 

Results: In the elderly, the estimated numbers of infection per 100,000 population are reduced by a median of 261.5 (range across settings: 154.4, 475.7) when moving the elderly to iTV and by 150.8 (77.6, 262.3) when moving them to QV. Through indirect protection, adopting mass paediatric programmes with 25% uptake achieves similar reductions in the elderly of 233.6 using TV (range: 58.9, 425.6) or 266.5 using QV (65.7, 477.9), with substantial health gains from averted infections across ages. At €35,000/QALY gained, moving the elderly to iTV plus adopting mass paediatric QV programmes provides the highest mean net benefits and probabilities of being cost-effective in all settings and paediatric coverage levels. 

Conclusion: Given the direct and indirect protection, and depending on the vaccine prices, model results support a combination of having moved the elderly to an improved vaccine and adopting universal paediatric vaccination programmes across the European settings.

Original languageEnglish
Pages (from-to)1306-1315
Number of pages10
Issue number9
Early online date31 Jan 2022
Publication statusPublished - 23 Feb 2022

Bibliographical note

Funding Information: This study was conducted as part of the I-MOVE+ (Integrated Monitoring of Vaccines in Europe) project, which had received a grant from the European Commission Horizon 2020 research and innovation programme (grant agreement No 634446). MB also thanks the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Modelling Methodology at Imperial College London in partnership with UK Health Security Agency (UKHSA) for funding (grant HPRU-2012–10080). The funders of the study had no role in study design, data collection and analysis, interpretation, decision to publish, or preparation of the manuscript. FGS, EvL, RP, and MB had full access to all the data in the study and had final responsibility for the decision to submit for publication. The views expressed are those of the authors and do not necessarily represent those of the funders or of any of the institutions to which the authors are affiliated.

Open Access: This is an open access article under the CC BY license (

Publisher Copyright: © 2022 The Authors. Published by Elsevier Ltd.

Citation: Sandmann, Frank G., et al. "Health and economic impact of seasonal influenza mass vaccination strategies in European settings: A mathematical modelling and cost-effectiveness analysis." Vaccine (2022).



  • Economic evaluation
  • Influenza
  • Mathematical model
  • Policy
  • Public health
  • Vaccination


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