Estimates of influenza vaccine effectiveness in primary care in Scotland vary with clinical or laboratory endpoint and method: experience across the 2010/11 season

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Abstract

Aim: This study examines estimation of seasonal influenza vaccine effectiveness (VE) for a cohort of patients attending general practice in Scotland in 2010/11. The study focuses on the variation in estimation of VE for both virological and clinical consultation outcomes and understanding the dependency on date of analysis during the season, methodological approach and the effect of use of a propensity score model.
Methods: For the clinical outcomes, three methodological approaches were considered; adjusted Poissonmulti-level modelling splitting consultations in vaccinated individuals into those before and after vaccination, adjusted Cox proportional hazards modelling and finally the screening method. For the virological outcome, the test-negative case–control study design was employed.
Results: VE was highest for the most specific outcomes of ILI (Poisson end-of-season VE = 47% (95% CI:−69%, 83%); Cox VE = 34% (95% CI: −64%, 73.2%); Screening VE = 52.8% (95% CI: 3.8%, 76.8%)) and a viro-logical diagnosis (VE = 54% (95% CI: −37%, 85%)). Using the Cox approach, adjusted for propensity scoreonly gave VE = 46.5% (95% CI: −30.4%, 78.0%).
Conclusion: Our approach illustrated the ability to achieve relatively consistent estimates of seasonalinfluenza VE using both specific and less specific outcomes. Construction of a propensity score and usefor bias adjustment increased the estimate of ILI VE estimated from the Cox model and made estimatesmore similar to the Poisson approach, which models differences in consultation behaviour of vacci-nated individuals more inherently in its structure. VE estimation for the same data was found to vary bymethodology which should be noted when comparing results from different studies and countries.
LanguageEnglish
Pages4556-4563
Number of pages8
JournalVaccine
Volume31
Issue number41
Early online date6 Aug 2013
DOIs
Publication statusPublished - 2013

Fingerprint

Primary Care
Influenza Vaccines
Vaccine
Influenza
Scotland
endpoints
influenza
Primary Health Care
Vaccines
Vary
vaccines
Estimate
methodology
Propensity Score
Referral and Consultation
Screening
Siméon Denis Poisson
Experience
screening
Consistent Estimates

Keywords

  • vaccine effectiveness
  • seasonal influenza
  • primary care
  • scotland
  • clinical
  • endpoint and method
  • laboratory

Cite this

@article{6f4dc1d6dc9045b090c5a05e6db8240d,
title = "Estimates of influenza vaccine effectiveness in primary care in Scotland vary with clinical or laboratory endpoint and method: experience across the 2010/11 season",
abstract = "Aim: This study examines estimation of seasonal influenza vaccine effectiveness (VE) for a cohort of patients attending general practice in Scotland in 2010/11. The study focuses on the variation in estimation of VE for both virological and clinical consultation outcomes and understanding the dependency on date of analysis during the season, methodological approach and the effect of use of a propensity score model. Methods: For the clinical outcomes, three methodological approaches were considered; adjusted Poissonmulti-level modelling splitting consultations in vaccinated individuals into those before and after vaccination, adjusted Cox proportional hazards modelling and finally the screening method. For the virological outcome, the test-negative case–control study design was employed.Results: VE was highest for the most specific outcomes of ILI (Poisson end-of-season VE = 47{\%} (95{\%} CI:−69{\%}, 83{\%}); Cox VE = 34{\%} (95{\%} CI: −64{\%}, 73.2{\%}); Screening VE = 52.8{\%} (95{\%} CI: 3.8{\%}, 76.8{\%})) and a viro-logical diagnosis (VE = 54{\%} (95{\%} CI: −37{\%}, 85{\%})). Using the Cox approach, adjusted for propensity scoreonly gave VE = 46.5{\%} (95{\%} CI: −30.4{\%}, 78.0{\%}).Conclusion: Our approach illustrated the ability to achieve relatively consistent estimates of seasonalinfluenza VE using both specific and less specific outcomes. Construction of a propensity score and usefor bias adjustment increased the estimate of ILI VE estimated from the Cox model and made estimatesmore similar to the Poisson approach, which models differences in consultation behaviour of vacci-nated individuals more inherently in its structure. VE estimation for the same data was found to vary bymethodology which should be noted when comparing results from different studies and countries.",
keywords = "vaccine effectiveness, seasonal influenza , primary care, scotland, clinical , endpoint and method, laboratory",
author = "Kimberley Kavanagh and Charles Robertson and Jim McMenamin",
note = "Now have volume number",
year = "2013",
doi = "10.1016/j.vaccine.2013.07.056",
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volume = "31",
pages = "4556--4563",
journal = "Vaccine",
issn = "0264-410X",
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T2 - Vaccine

AU - Kavanagh, Kimberley

AU - Robertson, Charles

AU - McMenamin, Jim

N1 - Now have volume number

PY - 2013

Y1 - 2013

N2 - Aim: This study examines estimation of seasonal influenza vaccine effectiveness (VE) for a cohort of patients attending general practice in Scotland in 2010/11. The study focuses on the variation in estimation of VE for both virological and clinical consultation outcomes and understanding the dependency on date of analysis during the season, methodological approach and the effect of use of a propensity score model. Methods: For the clinical outcomes, three methodological approaches were considered; adjusted Poissonmulti-level modelling splitting consultations in vaccinated individuals into those before and after vaccination, adjusted Cox proportional hazards modelling and finally the screening method. For the virological outcome, the test-negative case–control study design was employed.Results: VE was highest for the most specific outcomes of ILI (Poisson end-of-season VE = 47% (95% CI:−69%, 83%); Cox VE = 34% (95% CI: −64%, 73.2%); Screening VE = 52.8% (95% CI: 3.8%, 76.8%)) and a viro-logical diagnosis (VE = 54% (95% CI: −37%, 85%)). Using the Cox approach, adjusted for propensity scoreonly gave VE = 46.5% (95% CI: −30.4%, 78.0%).Conclusion: Our approach illustrated the ability to achieve relatively consistent estimates of seasonalinfluenza VE using both specific and less specific outcomes. Construction of a propensity score and usefor bias adjustment increased the estimate of ILI VE estimated from the Cox model and made estimatesmore similar to the Poisson approach, which models differences in consultation behaviour of vacci-nated individuals more inherently in its structure. VE estimation for the same data was found to vary bymethodology which should be noted when comparing results from different studies and countries.

AB - Aim: This study examines estimation of seasonal influenza vaccine effectiveness (VE) for a cohort of patients attending general practice in Scotland in 2010/11. The study focuses on the variation in estimation of VE for both virological and clinical consultation outcomes and understanding the dependency on date of analysis during the season, methodological approach and the effect of use of a propensity score model. Methods: For the clinical outcomes, three methodological approaches were considered; adjusted Poissonmulti-level modelling splitting consultations in vaccinated individuals into those before and after vaccination, adjusted Cox proportional hazards modelling and finally the screening method. For the virological outcome, the test-negative case–control study design was employed.Results: VE was highest for the most specific outcomes of ILI (Poisson end-of-season VE = 47% (95% CI:−69%, 83%); Cox VE = 34% (95% CI: −64%, 73.2%); Screening VE = 52.8% (95% CI: 3.8%, 76.8%)) and a viro-logical diagnosis (VE = 54% (95% CI: −37%, 85%)). Using the Cox approach, adjusted for propensity scoreonly gave VE = 46.5% (95% CI: −30.4%, 78.0%).Conclusion: Our approach illustrated the ability to achieve relatively consistent estimates of seasonalinfluenza VE using both specific and less specific outcomes. Construction of a propensity score and usefor bias adjustment increased the estimate of ILI VE estimated from the Cox model and made estimatesmore similar to the Poisson approach, which models differences in consultation behaviour of vacci-nated individuals more inherently in its structure. VE estimation for the same data was found to vary bymethodology which should be noted when comparing results from different studies and countries.

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