Table 1:
Model Input Parameters.
| Model Inputs | Pregnant women | New-borns | PLWHA | Persons with other UMC | Persons aged ≥ 65 years | Children aged 6–59 months | Source |
|---|---|---|---|---|---|---|---|
| Population size | 323 889± | - | 6 429 938 | 8 995 290 | 3 014 877 | 5 203 824 | [39,66] |
| Vaccine coverage | 48.90%± | - | 5.51% | 3.14% | 3.11% | 2.4% | [16,32,36,39] |
| Burden of disease (per 100,000 population) | |||||||
| Non-medically attended illness | 11 378 (8 306–14 450) | 18 280 (12 430–24 129) | 15 470 (11 602–19 337) | 15 226 (11 267–19 185) | 2 488 (1 018–4042) | 18,978 (13 664–24292) | [39] |
| Influenza-associated Out-patient visits | 4 676 (3 414–5939) | 8 585 (5 838–11332) | 5 290 (3 967–6612) | 5 290 (3 914–6665) | 653 (270–1 036) | 5 279 (3 801–6757) | [39] |
| Influenza-associated Hospitalisations | 425 (310–540) | 539 (366–711) | 296 (222–370) | 112 (83–142) | 329 (144–570) | 234 (168–299) | [39] |
| Influenza-associated Deaths | 16 (12–21) | 61 (41–80) | 81 (60–101) | 28 (21–36) | 138 (57–248) | 17 (12–21) | [39] |
| Vaccine-associated mild adverse events | 12 000 (6 000–18 000) | 12 000 (6 000–18 000) | 12 000 (6 000–18 000) | 12 000 (6 000–18 000) | 12 000 (6 000–18 000) | 12 000 (6 000–18 000) | [68] |
| Vaccine-associated severe adverse events | 0.15 (0.075–0.225) | 0.15 (0.075–0.225) | 0.15 (0.075–0.225) | 0.15 (0.075–0.225) | 0.15 (0.075–0.225) | 0.15 (0.075–0.225) | [68] |
| Vaccine efficacy | 33%* (9%−47%) | 17%* (4%−24%) | 44% (39%−47%) | 58% (34%−73%) | 58% (34%−73%) | 36%** (27%−44%) | [10,12,14,57,59,60] |
| Direct medical costs (2018 US$) | |||||||
| Vaccine price | 3.04 (1.26–5.01) | 0.00 (0.00–0.00) | 3.04 (1.26–5.01) | 3.04 (1.26–5.01) | 3.04 (1.26–5.01) | 6.07 (2.53–10.02) | [65] |
| Vaccine programme delivery costs | 5.42 (2.71–8.13) | 0.00 (0.00–0.00) | 5.42 (2.71–8.13) | 5.42 (2.71–8.13) | 5.42 (2.71–8.13) | 8.11 (4.06–12.17) | [65] |
| Out-patient visits | 24 (10–38) | 25 (13–36) | 25 (15–35) | 25 (15–35) | 25 (15–34) | 25 (16–33) | [66] |
| Hospitalisations | 945 (305–1855) | 649 (258–1192) | 888(406–1543) | 835 (401–1420) | 865 (402–1274) | 604 (294–1019) | [66] |
| Mild adverse events † | 1.16 (0.58–1.74) | 1.16 (0.58–1.74) | 1.16 (0.58–1.74) | 1.16 (0.58–1.74) | 1.16 (0.58–1.74) | 1.16 (0.58–1.74) | [70] |
| Severe adverse events †† | 4 981 (1 974–12688) | 4 981 (1 974–12688) | 4 981 (1 974–12688) | 4 981 (1 974–12688) | 4 981 (1 974–12688) | 4 981 (1 974–12688) | [69,70] |
| Direct non-medical costs (2018 US$) | |||||||
| Non-medically attended illness | 5 (4–6) | 5 (4–6) | 5 (4–5) | 5 (4–6) | 5 (4–6) | 5 (4–5) | [66] |
| Out-patient visits | 2 (1–2) | 2 (1–2) | 2 (1–3) | 2 (1–3) | 2 (1–2) | 3 (2–3) | [66] |
| Hospitalisations | 14 (9–20) | 14 (9–20) | 13 (8–18) | 13 (8–18) | 13 (8–18) | 14 (8–19) | [66] |
| Indirect costs (2018 US$) | |||||||
| Non-medically attended illness | 6 (3–16) | 11 (4–24) | 10 (3–25) | 9 (2–22) | 3 (1–18) | 11 (4–22) | [66] |
| Out-patient visits | 8 (4–17) | 13 (5–31) | 10 (4–26) | 10 (4–26) | 4 (1–08) | 12 (5–28) | [66] |
| Hospitalisations | 31 (11–66) | 17 (6–35) | 54 (20–113) | 54 (20–113) | 6 (2–09) | 13 (5–29) | [66] |
| Deaths | 19 624 (11 039–24 530) | 42 610 (23 968–53 263) | 32 361 (18 203–40 451) | 38 816(21 834–48 519) | 0 (0–0) | 42 001 (23 626–52502) | [66] |
| QALY loss | |||||||
| Influenza-associated mild illness | 0.009 (0.007–0.011) | 0.009 (0.007–0.011) | 0.009 (0.007–0.011) | 0.009 (0.007–0.011) | 0.009 (0.007–0.011) | 0.009 (0.007–0.011) | [61] |
| Influenza-associated severe illness | 0.031 (0.025–0.037) | 0.031 (0.025–0.037) | 0.031 (0.025–0.037) | 0.031 (0.025–0.037) | 0.031 (0.025–0.037) | 0.031 (0.025–0.037) | [61] |
| Influenza-associated mortality | 8.79 | 17.45 | 9.16 | 11.45 | 3.72 | 17.35 | [33,37,63] |
| Vaccine-associated mild adverse event‡ | 0.009 (0.007–0.011) | 0.009 (0.007–0.011) | 0.009 (0.007–0.011) | 0.009 (0.007–0.011) | 0.009 (0.007–0.011) | 0.009 (0.007–0.011) | Assumption |
| Vaccine-associated severe adverse event | 0.090 (0.050–0.067) | 0.107 (0.060–0.080) | 0.090 (0.051–0.068) | 0.090 (0.051–0.068) | 0.066 (0.037–0.050) | 0.107 (0.060–0.080) | [33,63,69,87] |
| Ave. life expectancy | 30.3 | 63.3 | 27.4 ‡‡ | 34.2 | 7.7 | 62.6 | [62,64] |
Vaccine efficacy for pregnant women and new-borns weighted by probability of still being pregnant or born, respectively during the influenza season and at risk
Two-dose vaccine efficacy for children. We assume that all children received two doses of trivalent inactivated influenza vaccine
Cost of vaccine mild adverse event assumed to be the same as costs associated with an out-patient visit for a mild influenza case. In the model we assumed that 10% of individuals with mild adverse event will seek outpatient care
Cost of severe adverse event assumed to be same as cost of hospitalisation for a severe acute respiratory infection
In absence of QALY estimate in the literature, assumed to be similar to mild influenza illness event, due to similarity of presentation (pain and fever)
Assumed to be 80% of the rest of the population [51]
PLWHA: Persons living with HIV/AIDS
UMC: Underlying Medical Conditions
Population of women pregnant during the 2018 influenza season. Total population of pregnant women in 2018 ≈925,000