Evaluation of the economic effectiveness of influenza vaccination in the Russian Federation as a result of prevented cases of morbidity and mortality

Introduction. Influenza remains a global public health problem due to high morbidity, associated mortality, and economic losses. Vaccination is a key tool for the disease control.

The purpose of the study. To assess the epidemiological and economic effectiveness of influenza vaccination programs in the Russian Federation from 2010 to 2022 through analysis of prevented cases of morbidity, mortality, and related losses.

Materials and methods. A retrospective analysis of data from Rosstat and Rospotrebnadzor was conducted. Regression modeling was applied to evaluate the association between vaccination coverage and influenza and influenza related morbidity/mortality with a one-year lag. Economic effectiveness was assessed according to the guidelines MR 5.1.0095–14 "Calculation of actual and prevented economic losses from mortality, morbidity, and disability of the population associated with the negative impact of environmental factors".

Results. At the national level, mortality ranged from 0.22 per 100,000 population in 2011 to 0.42 per 100,000 in 2014; the lowest morbidity was recorded in 2014 (9.02 per 100,000), and the highest in 2011 (216.5 per 100,000). Statistically significant inverse correlations (p < 0.05) were found between vaccination coverage and the morbidity/mortality rates of the considered nosologies. Model-based estimates indicated vaccination to prevent up to 92.1 thousand influenza cases annually among children, 1.772 million influenza-associated ARVI cases, and 1,432 influenza-associated pneumonia deaths among adults. The cost-benefit ratio of influenza vaccination campaigns ranged from 2.21 (2019) to 3.48 rubles per 1 ruble invested (2011). The total prevented economic losses were estimated at 54.49 billion rubles in 2011 and 102.48 billion rubles in 2019.

Research limitations. The study’s limitations include the set of analyzed data, the mathematical modeling methods used, and the estimates of influenza-associated morbidity and mortality.

Conclusion. The findings confirm that influenza vaccination programs are effective medical and economic strategies that significantly contribute to reducing the disease burden and strengthening public health in Russia.

Compliance with ethical standards. The study does not require the approval of a biomedical ethics committee of other documents (the study was performed using publicly available official statistics).

Contribution of the authors:
Zaitseva N.V. — research concept and design, editing, approval of the final version of the article;
Kleyn S.V. — editing, writing the text, approval of the final version of the article;
Glukhikh M.V. — statistical data processing, collection and processing material, writing the text.
All authors are responsible for the integrity of all parts of the manuscript and approval of the manuscript final version.

Funding. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: September 3, 2025 / Accepted: October 8, 2025 / Published: December 17, 2025

1. WHO. Influenza (seasonal); 2025. Available at: https://who.int/news-room/fact-sheets/detail/influenza-(seasonal)

2. Majeed B., David J.F., Bragazzi N.L., McCarthy Z., Grunnill M.D., Heffernan J., et al. Mitigating co-circulation of seasonal influenza and COVID-19 pandemic in the presence of vaccination: A mathematical modeling approach. Front. Public Health. 2023; 10: 1086849. https://doi.org/10.3389/fpubh.2022.1086849

3. Hwang J.H., You Y.S., Yeom S.W., Lee M.G., Lee J.H., Kim M.G., et al. Influenza viral infection is a risk factor for severe illness in COVID-19 patients: a nationwide population-based cohort study. Emerg. Microbes Infect. 2023; 12(1): 2164215. https://doi.org/10.1080/22221751.2022.2164215

4. Trombetta C.M., Kistner O., Montomoli E., Viviani S., Marchi S. Influenza viruses and vaccines: the role of vaccine effectiveness studies for evaluation of the benefits of influenza vaccines. Vaccines. 2022; 10(5): 714. https://doi.org/10.3390/vaccines10050714

5. Clayville L.R. Influenza update: a review of currently available vaccines. P & T. 2011; 36(10): 659–84.

6. Jefferson T., Rivetti A., Di Pietrantonj C., Demicheli V. Vaccines for preventing influenza in healthy children. Cochrane Database Syst. Rev. 2018; 2(2): CD004879. https://doi.org/10.1002/14651858.CD004879.pub5

7. Demicheli V., Jefferson T., Ferroni E., Rivetti A., Di Pietrantonj C. Vaccines for preventing influenza in healthy adults. Cochrane Database Syst. Rev. 2018; 2(2): CD001269. https://doi.org/10.1002/14651858.CD001269.pub6

8. Demicheli V., Jefferson T., Di Pietrantonj C., Ferroni E., Thorning S., Thomas R.E., et al. Vaccines for preventing influenza in the elderly. Cochrane Database Syst. Rev. 2018; 2(2): CD004876. https://doi.org/10.1002/14651858.CD004876.pub4

9. Bussink-Voorend D., Hautvast J.L.A., Vandeberg L., Visser O., Hulscher M.E.J.L. A systematic literature review to clarify the concept of vaccine hesitancy. Nat. Hum. Behav. 2022; 6(12): 1634–48. https://doi.org/10.1038/s41562-022-01431-6

10. Newall A.T., Chaiyakunapruk N., Lambach P., Hutubessy R.C.W. WHO guide on the economic evaluation of influenza vaccination. Influenza Other Respir. Viruses. 2018; 12(2): 211–9. https://doi.org/10.1111/irv.12510

11. Peasah S.K., Azziz-Baumgartner E., Breese J., Meltzer M.I., Widdowson M.A. Influenza cost and cost-effectiveness studies globally — a review. Vaccine. 2013; 31(46): 5339–48. https://doi.org/10.1016/j.vaccine.2013.09.013

12. Pallas S.W., Ahmeti A., Morgan W., Preza I., Nelaj E., Ebama M., et al. Program cost analysis of influenza vaccination of health care workers in Albania. Vaccine. 2020; 38(2): 220–7. https://doi.org/10.1016/j.vaccine.2019.10.027

13. Susilarini N.K., Haryanto E., Praptiningsih C.Y., Mangiri A., Kipuw N., Tarya I., et al. Estimated incidence of influenza-associated severe acute respiratory infections in Indonesia, 2013–2016. Influenza Other Respir. Viruses. 2018; 12(1): 81–7. https://doi.org/10.1111/irv.12496

14. Kyi-Kokarieva V.G., Kriachkova L.V., Padalkо L.I. Socio-economic substantiation of expediency of seasonal influenza vaccine prophylaxis among medical workers. Medical Perspectives/Medičnì Perspektivi. 2021; 26(4): 205–12. https://doi.org/10.26641/2307-0404.2021.4.248235

15. de Fougerolles T.R., Baïssas T., Perquier G., Vitoux O., Crépey P., Bartelt-Hofer J., et al. Public Health and Economic Benefits of Seasonal Influenza Vaccination in Risk Groups in France, Italy, Spain and the UK: State of Play and Perspectives. BMC Public Health. 2024; 24(1): 1221. https://doi.org/10.1186/s12889-024-18694-5

16. Chuchalin A.G., Avdeev S.N., Chernyaev A.L., Osipova G.L., Samsonova M.V. Federal clinical guidelines of the Russian Respiratory Society for the diagnosis and treatment of severe forms of influenza. Pul’monologiya. 2014; (5): 11–9. https://doi.org/10.18093/0869-0189-2014-0-5-11-19 https://elibrary.ru/tccdad (in Russian)

17. Pérez-Rubio A., Platero L., Eiros Bouza J.M. Seasonal influenza in Spain: Clinical and economic burden and vaccination programmes. Med. Clin. (Barc.). 2019; 153(1): 16–27. https://doi.org/10.1016/j.medcli.2018.11.014

18. Chen D., Zhang T., Chen S., Ru X., Shao Q., Ye Q., et al. The effect of nonpharmaceutical interventions on influenza virus transmission. Front. Public Health. 2024; 12: 1336077. https://doi.org/10.3389/fpubh.2024.1336077

19. Faherty L.J., Nascimento de Lima P., Lim J.Z., Roberts D., Karr S., Lawson E., et al. Effects of non-pharmaceutical interventions on COVID-19 transmission: rapid review of evidence from Italy, the United States, the United Kingdom, and China. Front. Public Health. 2024; 12: 1426992. https://doi.org/10.3389/fpubh.2024.1426992

20. Popova A.Yu., Zaitseva N.V., Alekseev V.B., Letyushev A.N., Kiryanov D.A., Kleyn S.V., et al. Heterogeneity of the modified SIR-model parameters of waves of COVID-19 epidemic process in the Russian Federation. Gigiena i Sanitaria (Hygiene and Sanitation, Russian journal). 2023; 102(8): 740–9. https://doi.org/10.47470/0016-9900-2023-102-8-740-749 https://elibrary.ru/rdotzd (in Russian)

21. Zaitseva N.V., Kleyn S.V., Glukhikh М.V. Spatial-dynamic heterogeneity of the COVID-19 epidemic process in the Russian Federation regions (2020–2023). Health Risk Analysis. 2023; (2): 4–16. https://doi.org/10.21668/health.risk/2023.2.01.eng (in Russian)

22. Yin J.K., Salkeld G., Heron L., Khandaker G., Rashid H., Booy R. The threat of human influenza: the viruses, disease impacts, and vaccine solutions. Infect. Disord. Drug Targets. 2014; 14(3): 150–4. https://doi.org/10.2174/1871526514666141014150907