Cost-Effectiveness of Routine Childhood Vaccination Against Seasonal Influenza in Germany

In Germany, routine influenza vaccination with quadrivalent influenza vaccines (QIV) is recommended and reimbursed for individuals ≥60 years of age and individuals with underlying chronic conditions. The present study examines the cost-effectiveness of a possible extension of the recommendation to include strategies of childhood vaccination against seasonal influenza using QIV. A dynamic transmission model was used to examine the epidemiological impact of different childhood vaccination strategies. The outputs were used in a health economic decision tree to calculate the costs per quality-adjusted life year (QALY) gained from a societal and a third-party payer (TPP) perspective. Strain-specific epidemiology, vaccine uptake, and vaccine efficacy data from the 10 non-pandemic seasons from 2003/2004 to 2013/2014 were used, and cost data were drawn mainly from a health insurance claims data analysis and supplemented by estimates from literature. Uncertainty is explored via scenario, deterministic, and probabilistic sensitivity analyses. Vaccinating 2- to 9-year-olds with QIV assuming a vaccine uptake of 40% is cost-saving with a benefit–cost ratio of 1.66 from a societal perspective and an incremental cost-effectiveness ratio of €998/QALY from a TPP perspective. Lower and higher vaccine uptakes show marginal effects, while extending the target group to 2- to 17-year-olds further increases the health benefits while still being below the willingness-to-pay (WTP) threshold. Assuming no vaccine-induced herd protection has a negative effect on the cost-effectiveness ratio, but childhood vaccination remains cost-effective. Routine childhood vaccination against seasonal influenza in Germany is most likely to be cost-saving from a societal perspective and highly cost-effective from a TPP perspective. •Routine childhood vaccination against seasonal influenza has been shown to be cost-effective using a trivalent inactivated vaccine (TIV) and a trivalent live attenuated influenza vaccine (LAIV) in many countries. The evidence concerning quadrivalent influenza vaccines (QIV) and quadrivalent live attenuated influenza vaccine (QLAIV) is limited, and studies focusing on QLAIV might need to be revisited based on the evidence related to the effectiveness of QLAIV that has emerged over recent years.•The article supplements the currently limited knowledge on potential population effects and cost-effectiveness of a routine childhood vaccination against influenza using QIV. This