Public Health and Economic Benefits of Influenza Vaccination of the Population Aged 50 to 59 Years without Risk Factors for Influenza Complications in Mexico: A Cross-Sectional Epidemiological Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Case Classifications
- Scenario 0: Symptomatic individual did not seek medical care, self-medicated with over-the-counter drugs, and had a complete recovery.
- Scenario 1: Symptomatic individual visited an outpatient clinic, had a positive PCR result for influenza, was managed only in ambulatory care, and had a complete recovery.
- Scenario 2: Symptomatic individual visited an outpatient clinic, had a positive PCR result for influenza and was referred for hospital care due to severity, had a complete recovery, and was discharged.
- Scenario 3: Symptomatic individual visited an outpatient clinic, had a positive PCR result for influenza and was referred for hospital care due to severity, and died.
- Scenario 4: Symptomatic individual visited a hospital emergency room (ER), had a positive PCR result for influenza, was discharged to an outpatient clinic for follow-up, and had a complete recovery.
- Scenario 5: Symptomatic individual visited a hospital ER, had a positive PCR result for influenza, was admitted to hospital for follow-up with non-severe clinical status, and had a complete recovery.
- Scenario 6: Symptomatic individual visited a hospital ER, had a positive PCR result for influenza, was admitted for follow-up with severe clinical status, and had a complete recovery.
- Scenario 7: Symptomatic individual visited a hospital ER, had a positive PCR result for influenza, was admitted to hospital for follow-up, and died.
2.2. Laboratory Diagnosis
2.3. Medical Consultations
2.4. Drugs
2.5. Days of Hospitalization
2.6. Days of Medical Disability Leave
2.7. Years of Life Lost
2.8. National Estimates of Influenza Cases
2.9. Estimation of the Population Without Risk Factors for Influenza Complications
2.10. Unit Costs for the Estimation of Economic Burden of Influenza
2.11. Costs of Vaccination
2.12. Vaccine Coverage and Effectiveness
2.13. Influenza Outcomes
2.14. Sensitivity Analysis
3. Results
3.1. Epidemiology
3.2. Hospital Discharges
3.3. Mortality
3.4. Cost-Effectiveness
3.5. Sensitivity Analysis
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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No Medical Care | Outpatient Only | Hospitalization: Referred from Outpatient Clinic | Hospitalization: Admitted through ER | |||||
---|---|---|---|---|---|---|---|---|
Scenario | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
Health Outcome | Not Demanding Medical Care | Outpatient Only | Hospitalization, Discharge | Hospital Care, Death | Outpatient | Hospitalization, Non-Severe | Hospitalization, Severe | Hospitalization, Death |
Clinical diagnosis | ||||||||
Outpatient consultations 1 | 1 | 1 | 1 | |||||
ER consultations 1 | 1 | 1 | 1 | 1 | ||||
PCR | 0.1 | 0.1 | 0.1 | 1 | 1 | 1 | 1 | |
Direct costs | ||||||||
Outpatient consultations 1 | 1 | |||||||
Specialist consultations 1 | 2 | 3 | 1 | 2 | 3 | 4 | ||
Amantadine 2 | 1 | |||||||
Oseltamivir 2 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | |
Paracetamol 2 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
Bacteriologic culture 2 | 1 | 1 | 1 | 1 | 1 | |||
Ceftriaxone 2 | 1 | 1 | 1 | 1 | 1 | |||
Hospitalization days | 1 | 8.3 | 2 | 8.3 | 12.45 | 8.3 | ||
Indirect costs | ||||||||
Medical disability days | 3 | 8 | 5 | 15 | 26 | |||
Years of life lost 3 | X | X |
Confirmed Cases | Deaths | |||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Initial Classification 2 | ILI | SARI | Total | ILI | SARI | Total | ||||||||||||
Season 3 | Influenza Type | Influenza Type | Influenza Type | Influenza Type | Influenza Type | Influenza Type | ||||||||||||
A | B | Total | A | B | Total | A | B | Total | A | B | Total | A | B | Total | A | B | Total | |
2009–2010 4 | 87 | 1 | 88 | 67 | 0 | 67 | 154 | 1 | 155 | 4 | 0 | 4 | 5 | 0 | 5 | 9 | 0 | 9 |
2010–2011 | 116 | 5 | 121 | 78 | 1 | 79 | 194 | 6 | 200 | 0 | 0 | 0 | 1 | 0 | 1 | 1 | 0 | 1 |
2011–2012 | 235 | 3 | 238 | 173 | 1 | 174 | 408 | 4 | 412 | 2 | 0 | 2 | 19 | 0 | 19 | 21 | 0 | 21 |
2012–2013 | 90 | 22 | 112 | 47 | 18 | 65 | 137 | 40 | 177 | 0 | 0 | 0 | 2 | 1 | 3 | 2 | 1 | 3 |
2013–2014 | 249 | 12 | 261 | 352 | 10 | 362 | 601 | 22 | 623 | 18 | 0 | 18 | 78 | 1 | 79 | 96 | 1 | 97 |
2014–2015 | 40 | 33 | 73 | 67 | 30 | 97 | 107 | 63 | 170 | 4 | 0 | 4 | 4 | 0 | 4 | 8 | 0 | 8 |
2015–2016 | 202 | 82 | 284 | 254 | 44 | 298 | 456 | 126 | 582 | 10 | 1 | 11 | 44 | 2 | 46 | 54 | 3 | 57 |
2016–2017 | 101 | 60 | 161 | 182 | 41 | 223 | 283 | 101 | 384 | 2 | 1 | 3 | 43 | 1 | 44 | 45 | 2 | 47 |
2017–2018 | 108 | 25 | 133 | 66 | 17 | 83 | 174 | 42 | 216 | 1 | 1 | 2 | 10 | 4 | 14 | 11 | 5 | 16 |
2018–2019 5 | 10 | 2 | 12 | 2 | 2 | 4 | 12 | 4 | 16 | 1 | 0 | 1 | 0 | 0 | 0 | 1 | 0 | 1 |
Period 2009–2019 | 1238 | 245 | 1483 | 1288 | 164 | 1452 | 2526 | 409 | 2935 | 42 | 3 | 45 | 206 | 9 | 215 | 248 | 12 | 260 |
Influenza Type | Subtype | Indicator | 2009–2010 | 2010–2011 | 2011–2012 | 2012–2013 | 2013–2014 | 2014–2015 | 2015–2016 | 2016–2017 | 2017–2018 | 2018–2019 | Period 2009–2019 |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
A | H1N1 | Cases | 128 | 11 | 366 | 16 | 509 | 27 | 316 | 184 | 65 | 11 | 1633 |
Deaths | 8 | 0 | 19 | 0 | 94 | 5 | 50 | 41 | 7 | 1 | 225 | ||
Lethality (%) | 6.25% | 0% | 5.19% | 0% | 18.47% | 18.52% | 15.82% | 22.28% | 10.77% | 9.09% | 13.78% | ||
H3N2 | Cases | 6 | 77 | 5 | 103 | 73 | 77 | 128 | 91 | 103 | 1 | 664 | |
Deaths | 0 | 0 | 0 | 2 | 2 | 2 | 2 | 3 | 3 | 0 | 14 | ||
Lethality (%) | 0% | 0% | 0% | 1.94% | 2.74% | 2.60% | 1.56% | 3.30% | 2.91% | 0% | 2.11% | ||
Not subtyped | Cases | 20 | 106 | 37 | 18 | 19 | 3 | 12 | 8 | 6 | 0 | 229 | |
Deaths | 1 | 1 | 2 | 0 | 0 | 1 | 2 | 1 | 1 | 0 | 9 | ||
Lethality (%) | 5.00% | 0.94% | 5.41% | 0% | 0% | 33.33% | 16.67% | 12.50% | 16.67% | 0% | 3.93% | ||
Total A | Cases | 154 | 194 | 408 | 137 | 601 | 107 | 456 | 283 | 174 | 12 | 2526 | |
Deaths | 9 | 1 | 21 | 2 | 96 | 8 | 54 | 45 | 11 | 1 | 248 | ||
Lethality (%) | 5.84% | 0.52% | 5.15% | 1.46% | 15.97% | 7.48% | 11.84% | 15.90% | 6.32% | 8.33% | 9.82% | ||
B | Victoria | Cases | 0 | 0 | 1 | 2 | 4 | 1 | 4 | 1 | 5 | 0 | 18 |
Deaths | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
Lethality (%) | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | ||
Yamagata | Cases | 0 | 0 | 0 | 8 | 4 | 24 | 34 | 34 | 25 | 2 | 131 | |
Deaths | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 3 | 0 | 4 | ||
Lethality (%) | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 2.94% | 12.00% | 0% | 3.05% | ||
Undetermined lineage | Cases | 1 | 6 | 3 | 30 | 14 | 38 | 88 | 66 | 12 | 2 | 260 | |
Deaths | 0 | 0 | 0 | 1 | 1 | 0 | 3 | 1 | 2 | 0 | 8 | ||
Lethality (%) | 0% | 0% | 0% | 3.33% | 7.14% | 0% | 3.41% | 1.52% | 16.67% | 0% | 3.08% | ||
Total B | Cases | 1 | 6 | 4 | 40 | 22 | 63 | 126 | 101 | 42 | 4 | 409 | |
Deaths | 0 | 0 | 0 | 1 | 1 | 0 | 3 | 2 | 5 | 0 | 12 | ||
Lethality (%) | 0% | 0% | 0% | 2.50 | 4.55 | 0% | 2.38% | 1.98% | 11.90% | 0% | 2.93% | ||
Total influenza | Cases | 155 | 200 | 412 | 177 | 623 | 170 | 582 | 384 | 216 | 16 | 2935 | |
Deaths | 9 | 1 | 21 | 3 | 97 | 8 | 57 | 47 | 16 | 1 | 260 | ||
Lethality (%) | 5.81% | 0.50% | 5.10% | 1.69% | 15.57% | 4.71% | 9.79% | 12.24% | 7.41% | 6.25% | 8.86% |
ICD-10 | Main Diagnosis | Discharges | Total Bed-Days | Average Bed-Days |
---|---|---|---|---|
J09X | Influenza due to certain identified influenza virus | 162 | 1851 | 11.4 |
J100 | Influenza with pneumonia, other influenza virus identified | 92 | 1007 | 10.9 |
J101 | Influenza with other respiratory manifestations, other influenza virus identified | 56 | 347 | 6.2 |
J108 | Influenza with other manifestations, other influenza virus identified | 15 | 62 | 4.1 |
J110 | Influenza with pneumonia, virus not identified | 307 | 2923 | 9.5 |
J111 | Influenza with other respiratory manifestations, virus not identified | 394 | 2431 | 6.2 |
J118 | Influenza with other manifestations, virus not identified | 39 | 210 | 5.4 |
Total | 1065 | 8831 | 8.3 |
Age Group | Season 1 | Average Mortality | ||||
---|---|---|---|---|---|---|
2010–2011 | 2011–2012 | 2012–2013 | 2013–2014 | 2014–2015 | ||
<1 | 0.8 | 1.3 | 1.0 | 1.2 | 0.4 | 0.9 |
1–4 | 0.1 | 0.1 | 0.4 | 0.2 | 0.1 | 0.2 |
5–11 | 0.0 | 0.0 | 0.0 | 0.1 | 0.0 | 0.0 |
12–17 | 0.1 | 0.0 | 0.0 | 0.1 | 0.0 | 0.0 |
18–49 | 0.1 | 0.2 | 0.0 | 0.7 | 0.0 | 0.2 |
50–59 | 0.8 | 0.9 | 0.0 | 2.0 | 0.1 | 0.8 |
≥60 | 1.3 | 1.0 | 0.1 | 2.0 | 0.3 | 0.9 |
Total | 0.2 | 0.3 | 0.1 | 0.8 | 0.1 | 0.3 |
Outcomes | No Influenza Immunization | Influenza Immunization | Influenza-Related Events Averted |
---|---|---|---|
Influenza cases | 797,918 | 598,418 | 199,500 |
Outpatient consultations | 268,004 | 200,996 | 67,008 |
Specialty consultations | 215,136 | 161,347 | 53,790 |
Emergency room consultations | 132,082 | 99,058 | 33,024 |
Hospitalizations | 132,349 | 99,258 | 33,091 |
Scenario | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | Cost |
---|---|---|---|---|---|---|---|---|---|
Direct costs | |||||||||
Laboratory diagnosis | 1.55 | 0.01 | 0.0000 | 8.27 | 4.87 | 2.78 | 0.01 | 17.48 | |
Medical consultations | 6.37 | 0.03 | 0.0001 | 4.55 | 3.90 | 3.05 | 0.01 | 17.90 | |
Drugs | 1.39 | 0.82 | 0.00 | 0.0000 | 0.44 | 0.26 | 0.15 | 0.00 | 3.06 |
Hospitalizations | 0.0018 | 32.32 | 72.33 | 61.80 | 0.09 | 166.61 | |||
Total direct costs | 1.39 | 8.74 | 0.09 | 0.00 | 45.57 | 81.37 | 67.78 | 0.10 | 205.04 |
Indirect costs | |||||||||
Productivity loss | 0.00 | 6.78 | 0.04 | 6.04 | 9.77 | 9.65 | 32.27 | ||
Premature death | 0.08 | 3.88 | 3.96 | ||||||
Total indirect costs | 0.00 | 6.78 | 0.04 | 0.08 | 6.04 | 9.77 | 9.65 | 3.88 | 36.23 |
Total costs of influenza | 1.39 | 15.52 | 0.13 | 0.08 | 51.61 | 91.14 | 77.42 | 3.99 | 241.27 |
Population to Vaccinate | Cost (US Dollars) |
---|---|
Total population 50–59 years | 6,444,501 |
At 50% vaccination coverage | |
Vaccinated population | 3,222,250 |
Cost of immunization | |
Cost per dose | 3.002 |
Application of vaccine | 0.236 |
Storage and transportation | 0.028 |
Unit cost per person immunized | 3.267 |
Total cost of immunization | |
Population 50–59 years | 10,525,569.95 |
No Influenza Immunization | Influenza Immunization | Net Costs | |
---|---|---|---|
Direct costs | |||
Laboratory diagnosis | 17.48 | 13.11 | −4.37 |
Medical consultations | 17.90 | 13.42 | −4.48 |
Drugs | 3.06 | 2.30 | −0.77 |
Hospitalizations | 166.61 | 124.95 | −41.66 |
Vaccination population aged 50–59 years | 10.53 | 10.53 | |
Net direct costs (Third party payer perspective) | 205.04 | 164.30 | −40.74 |
Indirect costs | |||
Productivity loss | 32.27 | 24.20 | −8.07 |
Premature death | 3.96 | 2.97 | −0.99 |
Net indirect costs | 36.23 | 27.17 | −9.06 |
Net total costs of influenza (Societal perspective) | 241.27 | 191.47 | −49.80 |
Scenario | Base Case | Conservative | Optimistic |
---|---|---|---|
0–Not demanding medical care | 132,939 | 30,314 | 253,110 |
1–Outpatient only | 33,471 | 7632 | 63,727 |
2–Hospitalization, discharge | 67 | 15 | 127 |
4–Outpatient | 17,885 | 4078 | 34,053 |
5–Hospitalization, non-severe | 9645 | 2199 | 18,363 |
6–Hospitalization, severe | 5494 | 1253 | 10,460 |
Total | 199,500 | 45,493 | 379,840 |
Events Avoided | Base Case | Conservative | Optimistic |
---|---|---|---|
Vaccination coverage | 50% | 30% | 70% |
Vaccine effectiveness | 50% | 19% | 68% |
Influenza cases | 199,500 | 45,493 | 379,840 |
Outpatient consultations | 67,008 | 15,280 | 127,580 |
Specialty consultations | 53,790 | 12,266 | 102,414 |
Emergency room consultations | 33,024 | 7531 | 62,876 |
Hospitalizations | 33,091 | 7546 | 63,003 |
Deaths | 12.1 | 2.8 | 23.0 |
Influenza-Associated Costs Averted | Base Case | Conservative | Optimistic |
---|---|---|---|
Vaccination coverage | 50% | 30% | 70% |
Vaccine effectiveness | 50% | 19% | 68% |
Direct Costs | |||
Laboratory diagnosis | −4.37% | −1.00% | −8.3% |
Medical consultations | −4.48% | −1.02% | −8.5% |
Drugs | −0.77% | −0.17% | −1.5% |
Hospitalizations | −41.66% | −9.50% | −79.3% |
Influenza immunization 50–59 years | +10.53% | +6.32% | +14.7% |
Total direct costs (Third-party payer perspective) | −40.74% | −5.38% | −82.9% |
Indirect costs | |||
Productivity loss | −8.07% | −1.84% | −15.4% |
Premature death | −0.99% | −0.23% | −1.9% |
Total indirect costs | −9.06% | −2.07% | −17.2% |
Total costs of influenza | −49.80% | −7.44% | −100.1% |
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Betancourt-Cravioto, M.; Falcón-Lezama, J.A.; Saucedo-Martínez, R.; Alfaro-Cortés, M.M.; Tapia-Conyer, R. Public Health and Economic Benefits of Influenza Vaccination of the Population Aged 50 to 59 Years without Risk Factors for Influenza Complications in Mexico: A Cross-Sectional Epidemiological Study. Vaccines 2021, 9, 188. https://doi.org/10.3390/vaccines9030188
Betancourt-Cravioto M, Falcón-Lezama JA, Saucedo-Martínez R, Alfaro-Cortés MM, Tapia-Conyer R. Public Health and Economic Benefits of Influenza Vaccination of the Population Aged 50 to 59 Years without Risk Factors for Influenza Complications in Mexico: A Cross-Sectional Epidemiological Study. Vaccines. 2021; 9(3):188. https://doi.org/10.3390/vaccines9030188
Chicago/Turabian StyleBetancourt-Cravioto, Miguel, Jorge Abelardo Falcón-Lezama, Rodrigo Saucedo-Martínez, Myrna María Alfaro-Cortés, and Roberto Tapia-Conyer. 2021. "Public Health and Economic Benefits of Influenza Vaccination of the Population Aged 50 to 59 Years without Risk Factors for Influenza Complications in Mexico: A Cross-Sectional Epidemiological Study" Vaccines 9, no. 3: 188. https://doi.org/10.3390/vaccines9030188