Assessment of Public Health and Economic Impact of Intranasal Live-Attenuated Influenza Vaccination of Children in France Using a Dynamic Transmission Model



We estimated the epidemiological and economic impact of extending the French influenza vaccination programme from at-risk/elderly (≥65 years) only to healthy children (2–17 years).


A deterministic, age-structured, dynamic transmission model was used to simulate the transmission of influenza in the French population, using the current vaccination coverage with trivalent inactivated vaccine (TIV) in at-risk/elderly individuals (current strategy) or gradually extending the vaccination to healthy children (aged 2–17 years) with intranasal, quadrivalent live-attenuated influenza vaccine (QLAIV) from current uptake up to 50% (evaluated strategy). Epidemiological, medical resource use and cost data were taken from international literature and country-specific information. The model was calibrated to the observed numbers of influenza-like illness visits/year. The 10-year number of symptomatic cases of confirmed influenza and direct medical costs (‘all-payer’) were calculated for the 0–17- (direct and indirect effects) and ≥18-year-old (indirect effect). The incremental cost-effectiveness ratio (ICER) was calculated for the total population, using a 4% discount rate/year.


Assuming 2.3 million visits/year and 1960 deaths/year, the model calibration yielded an all-year average basic reproduction number (R 0) of 1.27. In the population aged 0–17 years, QLAIV prevented 865,000 influenza cases/year (58.4%), preventing 10-year direct medical expenses of €374 million. In those aged ≥18 years with unchanged TIV coverage, 1.2 million cases/year were averted (27.6%) via indirect effects (additionally prevented expenses, €457 million). On average, 613 influenza-related deaths were averted annually overall. The ICER was €18,001/life-year gained. The evaluated strategy had a 98% probability of being cost-effective at a €31,000/life-year gained threshold.


The model demonstrated strong direct and indirect benefits of protecting healthy children against influenza with QLAIV on public health and economic outcomes in France.

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We thank Gilles Berdeaux for his role in the study and experts’ board conduct.

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Corresponding author

Correspondence to L. Gerlier.

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Financial support

This study was funded by an unrestricted grant from AstraZeneca France.

Conflicts of interest

LG and ML are employees of IMS Health, which received consulting fees from AstraZeneca. SG is employed by AstraZeneca. OD has conducted studies for and received honoraria from Herescon GmbH, which has received research support and consulting fees from AstraZeneca and MedImmune. MS is an employee and shareholder of ExploSYS GmbH, which has received payments from Epimos GmbH, a contract research and consulting institute, which has received research support and consulting fees from AstraZeneca. ME is a partner and shareholder of the contract research and consulting institute Epimos GmbH, which received consulting fees and research support from AstraZeneca, Novartis and GlaxoSmithKline. FC has received consulting fees from AstraZeneca and GlaxoSmithKline. XL has received consulting fees from AstraZeneca. CWO has received grants for congresses and honoraria for conferences and meetings from AstraZeneca, GlaxoSmithKline, Novartis, Pfizer, Sanofi-Pasteur, and Sanofi-Pasteur MSD.


ME and OD conceptualised the study, carried out the simulations and interpreted the results. MS designed and developed the simulation tool and provided technical support. LG provided local data input, analysed the simulation results and drafted the manuscript. CWO, FC and XL were part of the scientific committee of the project; they provided expertise and guidance on data input and assumptions. SG provided clinical data inputs and coordinated the discussions with the scientific committee. All authors critically appraised, corrected and validated the manuscript.

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Gerlier, L., Lamotte, M., Grenèche, S. et al. Assessment of Public Health and Economic Impact of Intranasal Live-Attenuated Influenza Vaccination of Children in France Using a Dynamic Transmission Model. Appl Health Econ Health Policy 15, 261–276 (2017).

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  • Influenza
  • Influenza Vaccine
  • Influenza Vaccination
  • Acute Otitis Medium
  • Vaccination Coverage