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Information used in the decision-making process regarding influenza vaccination policy: perceptions of stakeholders in France and the Netherlands.

Silva, M.L., Perrier, L., Paget, J., Mosnier, A., Buthion, V., Cohen, J.M., Späth, H.M. Information used in the decision-making process regarding influenza vaccination policy: perceptions of stakeholders in France and the Netherlands. Value in Health: 2014, 17(7) A 329. Abstract: ISPOR 17th Annual European Congress. Amsterdam – November, 2014.
Objectives
To minimize the medical and societal impact of influenza, most WHO countries recommend seasonal vaccination in targeted populations; however, little is known about the decision-making procedures at a country-level. In Europe, the Netherlands has the highest rate of influenza vaccination and France is not far behind. Our purpose was to analyze differences and similarities in the information used in the decision-making process between these two countries, according to the stakeholders involved.

Methods
A preliminary documentary analysis identified all stakeholders, at national level in both countries, as decision-makers (governmental authorities), advisors and information providers (research institutions, groups of experts), and vaccine manufacturers. We undertook a qualitative study including at least one actor from each stakeholder group involved in the process. Thirty-three faceto-face or telephone semi-structured interviews were conducted during summer 2013 in France (n= 16), and autumn 2013 in the Netherlands (n= 17). Every interview was recorded and transcribed. NVivo10® was used for the qualitative analysis.

Results
Stakeholders in France and the Netherlands follow international recommendations. The most relevant information is clinical trials and epidemiological studies. Economic models gained importance after the 2009 influenza pandemic, especially in the Netherlands. In both countries, the advice of experts is crucial. All types of studies are assessed through a standard checklist for public health vaccinations in the Netherlands. In France, the assessment is not standardized, but based on general checklists. Decision-makers are increasingly worried about the quality of studies, due to the lack of standardized methods and influenza uncertainty. When published studies are not generalizable, local studies are required.

Conclusions
Information used in the decision-making process is similar in both countries, although economic models have greater importance in the Netherlands. The excellence of the process is challenged by the poor quality of influenza data. Efforts should be made on standardization of study methods, together with harmonization of European policy. (aut. ref.)