, Volume 31, Issue 8, pp 693–702 | Cite as

Understanding the Cost-Effectiveness of Influenza Vaccination in Children: Methodological Choices and Seasonal Variability

  • Anthony T. NewallEmail author
  • Juan Pablo Dehollain
  • Prudence Creighton
  • Philippe Beutels
  • James G. Wood
Original Research Article



The universal vaccination of children for influenza has recently been recommended in the UK and is being considered in other developed countries.


The aim of this study was to explore the potential costs and benefits of childhood influenza vaccination to gain a better understanding of the key drivers of cost-effectiveness.


As our case study we examined the cost-effectiveness of vaccination in Australian schoolchildren using an age-stratified Susceptible Exposed Infectious Recovered model.


The results of this study highlight the critical role that methodological choices play in determining the cost-effectiveness of influenza vaccination. These choices include decisions about the structure of the model (including/excluding herd immunity) and what costs and benefits to include in the analysis. In scenarios where herd protection was included we estimated that the program was likely to be cost-effective. The study also illustrates the importance of the inherent seasonal variability of influenza, which can produce counter-intuitive results, with low transmission seasons being easier to control by vaccination but resulting in fewer benefits.


Universal childhood influenza vaccination is likely to be cost-effective if a substantial herd protection effect can be achieved by the program. However, it is important that decision makers understand the role of seasonal variability and the impact of alternative methodological choices in economic evaluations of influenza vaccination.


Influenza Influenza Vaccination Methodological Choice General Practitioner Visit Universal Vaccination 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This research was supported by a National Health and Medical Research Council (NHMRC) grant (630779). ATN holds an NHMRC Training Fellowship (630724—Australian Based Public Health Fellowship). ATN, JGW and PB are members of a Centre for Research Excellence (CRE) funded by the NHRMC (APP1031963).

Conflict of interest

ATN and JGW have in the past received research funding from a manufacturer of influenza vaccine for other previous projects.

Contribution of Authors

ATN initiated and led the project, methodological and parameterisation decisions, designed the structure of the economic aspects of the model, reviewed the literature and drafted the manuscript. JPD and PC reviewed the literature, assisted with parameterisation, helped to develop and edit the model, performed analysis, prepared figures and tables, and edited the manuscript. JW and PB were involved in model design and parameterisation decisions, and reviewed and modified the manuscript. JW also implemented and designed technical aspects of the dynamic model including calibration methods and averaging of ICER values. All authors approved the final manuscript. ATN acts as the guarantor for the project.

Supplementary material

40273_2013_60_MOESM1_ESM.doc (311 kb)
Supplementary material 1 (DOC 311 kb)


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Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Anthony T. Newall
    • 1
    Email author
  • Juan Pablo Dehollain
    • 1
  • Prudence Creighton
    • 1
  • Philippe Beutels
    • 1
    • 2
  • James G. Wood
    • 1
  1. 1.School of Public Health and Community Medicine, Faculty of MedicineUniversity of New South WalesSydneyAustralia
  2. 2.Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease InstituteUniversity of AntwerpAntwerpBelgium

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