Cost-effectiveness of pneumococcal and influenza vaccination standing order programs

OBJECTIVES

Despite the benefits of vaccination and guidelines for their use, the rates for influenza and pneumococcal vaccination remain below the 90% goal set by Healthy People 2010 for persons 65 years and older. Standing order programs (SOPs) authorize vaccination administration without physician orders. Here we examine the cost-effectiveness of SOPs to improve both pneumococcal and influenza vaccination rates in outpatient settings for individuals 65 years and older.

STUDY DESIGN

Decision analysis-based cost-effectiveness analysis.

METHODS

A Markov model was constructed to estimate the incremental cost-effectiveness of outpatient SOPs for pneumococcal polysaccharide vaccine (PPSV) and influenza vaccination in hypothetical US population cohorts 65 years and older. Vaccination rate improvement data were obtained from the medical literature. Centers for Disease Control and Prevention Active Bacterial Core surveillance data and US national databases were used to estimate costs and outcomes.

RESULTS

SOPs cost $14,171 per quality-adjusted life-year (QALY) gained compared with no program from a third-party payer perspective. In 1-way sensitivity analyses, the SOP strategy cost less than $50,000/QALY if SOPs increased absolute vaccination rates by 4% or more (base case: 18%), annual SOP costs were less than $21 per person (base case: $4.60), or annual influenza incidence was 4% or more (base case: 10%). Model results were insensitive to other individual parameter variations, and were supported by a probabilistic sensitivity analysis.

CONCLUSIONS

SOPs used to improve PPSV and influenza vaccination rates in outpatient settings is a promising and economically favorable investment, with cost-effectiveness analysis results remaining robust to parameter variation over clinically plausible ranges.

Influenza vaccination guidelines and vaccine sales in southeast Asia: 2008-2011

BACKGROUND

Southeast Asia is a region with great potential for the emergence of a pandemic influenza virus. Global efforts to improve influenza surveillance in this region have documented the burden and seasonality of influenza viruses and have informed influenza prevention strategies, but little information exists about influenza vaccination guidelines and vaccine sales.

METHODS

To ascertain the existence of influenza vaccine guidelines and define the scope of vaccine sales, we sent a standard three-page questionnaire to the ten member nations of the Association of Southeast Asian Nations. We also surveyed three multinational manufacturers who supply influenza vaccines in the region.

RESULTS

Vaccine sales in the private sector were <1000 per 100,000 population in the 10 countries. Five countries reported purchasing vaccine for use in the public sector. In 2011, Thailand had the highest combined reported rate of vaccine sales (10,333 per 100,000). In the 10 countries combined, the rate of private sector sales during 2010-2011 (after the A(H1N1)2009pdm pandemic) exceeded 2008 pre-pandemic levels. Five countries (Indonesia, Malaysia, Singapore, Thailand and Vietnam) had guidelines for influenza vaccination but only two were consistent with global guidelines. Four recommended vaccination for health care workers, four for elderly persons, three for young children, three for persons with underlying disease, and two for pregnant women.

CONCLUSIONS

The rate of vaccine sales in Southeast Asia remains low, but there was a positive impact in sales after the A(H1N1)2009pdm pandemic. Low adherence to global vaccine guidelines suggests that more work is needed in the policy arena.

Fighting transient epidemics-optimal vaccination schedules before and after an outbreak

Epidemic diseases afflict all countries, and all epidemics are costly to society. The present paper examines optimal vaccination trajectories before and after an outbreak of a special class of epidemics where the disease normally eradicates itself. The focus is on epidemics where mortality may be ignored, influenza being the prime example. One important insight is that there may be increasing returns to scale in vaccination.

Free vaccine programs to cocoon high-risk infants and children against influenza and pertussis

An adult immunization strategy called "cocooning" is a relatively new concept, referring to immunizing close contacts of infants and high-risk children, thereby limiting pathogen exposure. This report explores the adoption of free vaccine programs in US children's hospitals and shares our own institutions' experiences in implementing free vaccine programs for close contacts of our patients.

Economic evaluations of childhood influenza vaccination: a critical review

The potential benefits of influenza vaccination programmes targeted at children have gained increasing attention in recent years. We conducted a literature search of economic evaluations of influenza vaccination in those aged ≤18 years. The search revealed 20 relevant articles, which were reviewed. The studies differed widely in terms of the costs and benefits that were included. The conclusions were generally favourable for vaccination, but often applied a wider perspective (i.e. including productivity losses) than the reference case for economic evaluations used in many countries. Several evaluations estimated outcomes from a single-year epidemiological study, which may limit their validity given the year-to-year variation in influenza transmissibility, virulence, vaccine match and prior immunity. Only one study used a dynamic transmission model able to fully incorporate the indirect herd protection to the wider community. The use of dynamic models offers great scope to capture the population-wide implications of seasonal vaccination efforts, particularly those targeted at children.

Cost effectiveness of vaccination against pandemic influenza in European countries: mathematical modelling analysis

OBJECTIVE

To investigate whether a single optimal vaccination strategy exists across countries to deal with a future influenza pandemic by comparing the cost effectiveness of different strategies in various pandemic scenarios for three European countries.

DESIGN

Economic and epidemic modelling study.

SETTINGS

General populations in Germany, the Netherlands, and the United Kingdom.

DATA SOURCES

Country specific patterns of social contact and demographic data.

MODEL

An age structured susceptible-exposed-infected-recovered transmission model that describes how an influenza A virus will spread in the populations of Germany, the Netherlands, and the United Kingdom.

INTERVENTIONS

Comparison of four vaccination strategies: no vaccination, blanket vaccination, vaccination of elderly people (≥ 65 years), and vaccination of high transmitters (5-19 years). The four strategies were evaluated for scenarios in which a vaccine became available early or at the peak of the pandemic, and in which either everyone was initially susceptible or older age groups had pre-existing immunity.

MAIN OUTCOME MEASURE

Cost per quality adjusted life years (QALYs) gained.

RESULTS

All vaccination strategies were cost effective (incremental cost per QALY gained, comparing intervention with non-intervention). In scenarios where the vaccine became available at the peak of the pandemic and there was pre-existing immunity among elderly people the incremental cost effectiveness ratios for vaccinating high transmitters were €7325 (£5815; $10,470) per QALY gained for Germany, €10,216 per QALY gained for the Netherlands, and €7280 per QALY gained for the United Kingdom. The most cost effective strategy not only differed across the pandemic scenarios but also between countries. Specifically, when the vaccine was available early in the pandemic and there was no pre-existing immunity, in Germany it would be most cost effective to vaccinate elderly people ( €940 per QALY gained), whereas it would be most cost effective to vaccinate high transmitters in both the Netherlands (€525 per QALY gained) and the United Kingdom (€163 per QALY gained). This difference in optimal strategies was due to differences in the demographic characteristics of the countries: Germany has a significantly higher proportion of elderly people compared with the Netherlands and the United Kingdom.

CONCLUSIONS

No single vaccination strategy was most cost effective across countries. With aging populations, pre-existing immunity in particular could be of crucial importance for the cost effectiveness of options to mitigate a future influenza pandemic.

Cost comparison of 2 mass vaccination campaigns against influenza A H1N1 in New York City

Objectives. We estimated and compared total costs and costs per dose administered for 2 influenza A 2009 monovalent vaccine campaigns in New York City: an elementary school-located campaign targeting enrolled children aged 4 years and older, and a community-based points-of-dispensing campaign for anyone aged 4 years and older. Methods. We determined costs from invoices or we estimated costs. We obtained vaccination data from the Citywide Immunization Registry and reports from the community points of dispensing. Results. The school campaign delivered approximately 202,089 vaccines for $17.9 million and $88 per dose. The community campaign delivered 49,986 vaccines for $7.6 million and $151 per dose. At projected capacity, the school campaign could have delivered 371,827 doses at $53 each or $13 each when we excluded the value of in-kind resources. The community points of dispensing could have administered 174,000 doses at $51 each or $24 each when we excluded the value of in-kind resources. Conclusions. The school campaign delivered vaccines at a lower cost per dose than did the community campaign. Had demand been higher, both campaigns may have delivered vaccine at lower, more comparable cost per dose.

The potential economic value of a 'universal' (multi-year) influenza vaccine

BACKGROUND

Limitations of the current annual influenza vaccine have led to ongoing efforts to develop a 'universal' influenza vaccine, i.e., one that targets a ubiquitous portion of the influenza virus so that the coverage of a single vaccination can persist for multiple years.

OBJECTIVES

To estimate the economic value of a 'universal' influenza vaccine compared to the standard annual influenza vaccine, starting vaccination in the pediatric population (2-18 year olds), over the course of their lifetime.

PATIENT/METHODS

Monte Carlo decision analytic computer simulation model.

RESULTS

Universal vaccine dominates (i.e., less costly and more effective) the annual vaccine when the universal vaccine cost ≤ $100/dose and efficacy ≥ 75% for both the 5- and 10-year duration. The universal vaccine is also dominant when efficacy is ≥ 50% and protects for 10 years. A $200 universal vaccine was only cost-effective when ≥ 75% efficacious for a 5-year duration when annual compliance was 25% and for a 10-year duration for all annual compliance rates. A universal vaccine is not cost-effective when it cost $200 and when its efficacy is ≤ 50%. The cost-effectiveness of the universal vaccine increases with the duration of protection.

CONCLUSIONS

Although development of a universal vaccine requires surmounting scientific hurdles, our results delineate the circumstances under which such a vaccine would be a cost-effective alternative to the annual influenza vaccine.

Issues in the economic evaluation of influenza vaccination by injection of healthy working adults in the US: a review and decision analysis of ten published studies

The objective was to review recent economic evaluations of influenza vaccination by injection in the US, assess their evidence, and conclude on their collective findings. The literature was searched for economic evaluations of influenza vaccination injection in healthy working adults in the US published since 1995. Ten evaluations described in nine papers were identified. These were synopsized and their results evaluated, the basic structure of all evaluations was ascertained, and sensitivity of outcomes to changes in parameter values were explored using a decision model. Areas to improve economic evaluations were noted. Eight of nine evaluations with credible economic outcomes were favourable to vaccination, representing a statistically significant result compared with a proportion of 50% that would be expected if vaccination and no vaccination were economically equivalent. Evaluations shared a basic structure, but differed considerably with respect to cost components, assumptions, methods, and parameter estimates. Sensitivity analysis indicated that changes in parameter values within the feasible range, individually or simultaneously, could reverse economic outcomes. Given stated misgivings, the methods of estimating influenza reduction ascribed to vaccination must be researched to confirm that they produce accurate and reliable estimates. Research is also needed to improve estimates of the costs per case of influenza illness and the costs of vaccination. Based on their assumptions, the reviewed papers collectively appear to support the economic benefits of influenza vaccination of healthy adults. Yet the underlying assumptions, methods and parameter estimates themselves warrant further research to confirm they are accurate, reliable and appropriate to economic evaluation purposes.

Estimation of the health impact and cost-effectiveness of influenza vaccination with enhanced effectiveness in Canada

Introduction

The propensity for influenza viruses to mutate and recombine makes them both a familiar threat and a prototype emerging infectious disease. Emerging evidence suggests that the use of MF59-adjuvanted vaccines in older adults and young children enhances protection against influenza infection and reduces adverse influenza-attributable outcomes compared to unadjuvanted vaccines. The health and economic impact of such vaccines in the Canadian population are uncertain.

Methods

We constructed an age-structured compartmental model simulating the transmission of influenza in the Canadian population over a ten-year period. We compared projected health outcomes (quality-adjusted life years (QALY) lost), costs, and incremental cost-effectiveness ratios (ICERs) for three strategies: (i) current use of unadjuvanted trivalent influenza vaccine; (ii) use of MF59-adjuvanted influenza vaccine adults ≥65 in the Canadian population, and (iii) adjuvanted vaccine used in both older adults and children aged < 6.

Results

In the base case analysis, use of adjuvanted vaccine in older adults was highly cost-effective (ICER = $2111/QALY gained), but such a program was “dominated” by a program that extended the use of adjuvanted vaccine to include young children (ICER = $1612/QALY). Results were similar whether or not a universal influenza immunization program was used in other age groups; projections were robust in the face of wide-ranging sensitivity analyses.

Interpretation

Based on the best available data, it is projected that replacement of traditional trivalent influenza vaccines with MF59-adjuvanted vaccines would confer substantial benefits to vaccinated and unvaccinated individuals, and would be economically attractive relative to other widely-used preventive interventions.

An incremental economic evaluation of targeted and universal influenza vaccination in pregnant women

OBJECTIVE

Pregnancy is associated with increased influenza hospitalizations and physician visits (events) in healthy women and those with co-morbidities. Annual influenza immunization is recommended for all pregnant women. Although vaccination is expected to reduce influenza-related events, the economic implications are unclear. We developed an economic model to estimate the cost-effectiveness (CE) of different vaccination strategies in Nova Scotia.

METHODS

A decision tree characterized the one-year costs and consequences of targeted (pregnant women with co-morbidities only) and universal (all pregnant women) vaccination strategies relative to a no-vaccination strategy. Baseline event probabilities, vaccine effectiveness, costs and quality-of-life weights were derived from individual-level Nova Scotia administrative databases, health system sources and published reports. Sensitivity analyses tested the impact of varying key parameters, including vaccine effectiveness and mode of delivery.

RESULTS

Targeted vaccination was cost-saving relative to no vaccination when delivered by public health clinics (PHC) or routine family practitioner (FP) visit. Cost per quality-adjusted life year gained by universal vaccination relative to targeted strategy was < $40,000 when delivered by PHC or routine FP visit. Net cost of universal vaccination by PHC or a routine FP visit was < $10 per pregnant woman.

CONCLUSION

Universal vaccination of pregnant women appears cost-effective when delivered by PHC or as part of a routine FP prenatal visit. Targeted vaccination of pregnant women with co-morbidities can be cost-saving, but the possibility of higher vaccine uptake with a universal compared to a targeted strategy must be considered in addition to costs in program planning.

Cost-effectiveness of a recommendation of universal mass vaccination for seasonal influenza in the United States

OBJECTIVES

We evaluated the cost-effectiveness of universal mass vaccination (UMV) against influenza compared with a targeted vaccine program (TVP) for selected age and risk groups in the United States.

METHODS

We modeled costs and outcomes of seasonal influenza with UMV and TVP, taking a societal perspective. The US population was stratified to model age-specific (< 5, 5-17, 18-49, 50-64, and 65+ years) vaccine coverage and efficacy. Probability of influenza-related illness (ILI) and complications, health-care utilization, costs, and survival were estimated. For a season's intervention, ILI cases in that year, lifetime costs (2008 US$), and quality-adjusted life years (QALYs) lost (both discounted at 3% per annum) were calculated for each policy and used to derive incremental cost-effectiveness ratios. A range of sensitivity and alternative-scenario analyses were conducted.

RESULTS

In base-case analyses, TVP resulted in 63 million ILI cases, 859,000 QALYs lost, and $114.5 billion in direct and indirect costs; corresponding estimates for UMV were 61 million cases, 825,000 QALYs lost, and $111.4 billion. UMV was therefore estimated to dominate TVP, saving $3.1 billion and 34,000 QALYs. In probabilistic sensitivity analyses, UMV was dominant in 82% and dominated in 0% of iterations. In alternative-scenario analyses, UMV dominated TVP when lower estimates of vaccine coverage were used. Lower estimates of ILI risk among unvaccinated, vaccine effectiveness, and risk of complications resulted in ICERs of $2800, $8100, and $15,900 per QALY gained, respectively, for UMV compared with TVP.

CONCLUSIONS

UMV against seasonal influenza is cost saving in the United States under reasonable assumptions for coverage, cost, and efficacy.

[A cost-benefit analysis of the influenza H1N1 vaccination in the primary and junior school in Shanghai]

OBJECTIVE

To evaluate the cost-benefit for the Influenza Type A H1N1 Virus (Influenzae H1N1) vaccination in Shanghai primary and junior schools.

METHODS

A semi-experiment study was selected to evaluate the cost-benefit for Influenza H1N1 vaccination in primary and junior schools in 6 districts of Shanghai, including 414 636 students in total. According to the voluntary principle, the students were divided into the vaccinated group (233 445 students) and control group (181 191 students). The information of vaccine cost was collected from CDC in 19 districts in Shanghai by questionnaire; and the information of medical treatment cost was collected from questionnaire and abstracts of retrospective medical records, which included 31 mild cases and 15 severe cases. The cost-benefit analysis was conducted by health economic evaluation.

RESULTS

In total, there were 414 636 students enrolled in this study; while 233 445 (56.3%) students were in the vaccinated group and 181 191 in the control group. The attack rate in vaccinated group and control group was 0.61% (1433/233 445) and 1.76% (3166/181 191) respectively. The protection ratio was 65.34% ((1.76 - 0.61)/1.76) in the vaccinated group. The average cost of Influenza H1N1 was 36.81 yuan/person; and the average cost of medical treatment was (358.3 ± 243.6) yuan/mild case and (49 188.4 ± 99 917.3) yuan/severe case. The total benefit of vaccination in schools was 19 155 566.3 yuan, and the net benefit was 10 560 673.7 yuan. Therefore, the benefit-cost ratio was 2.24:1.

CONCLUSION

Influenza H1N1 vaccine could protect the students from Influenza H1N1 infection, and the cost-benefit analysis showed that the intervention strategy was worth trying.

Cost-effectiveness of 2009 pandemic influenza A(H1N1) vaccination in the United States

BACKGROUND

Pandemic influenza A(H1N1) (pH1N1) was first identified in North America in April 2009. Vaccination against pH1N1 commenced in the U.S. in October 2009 and continued through January 2010. The objective of this study was to evaluate the cost-effectiveness of pH1N1 vaccination.

METHODOLOGY

A computer simulation model was developed to predict costs and health outcomes for a pH1N1 vaccination program using inactivated vaccine compared to no vaccination. Probabilities, costs and quality-of-life weights were derived from emerging primary data on pH1N1 infections in the US, published and unpublished data for seasonal and pH1N1 illnesses, supplemented by expert opinion. The modeled target population included hypothetical cohorts of persons aged 6 months and older stratified by age and risk. The analysis used a one-year time horizon for most endpoints but also includes longer-term costs and consequences of long-term sequelae deaths. A societal perspective was used. Indirect effects (i.e., herd effects) were not included in the primary analysis. The main endpoint was the incremental cost-effectiveness ratio in dollars per quality-adjusted life year (QALY) gained. Sensitivity analyses were conducted.

RESULTS

For vaccination initiated prior to the outbreak, pH1N1 vaccination was cost-saving for persons 6 months to 64 years under many assumptions. For those without high risk conditions, incremental cost-effectiveness ratios ranged from $8,000-$52,000/QALY depending on age and risk status. Results were sensitive to the number of vaccine doses needed, costs of vaccination, illness rates, and timing of vaccine delivery.

CONCLUSIONS

Vaccination for pH1N1 for children and working-age adults is cost-effective compared to other preventive health interventions under a wide range of scenarios. The economic evidence was consistent with target recommendations that were in place for pH1N1 vaccination. We also found that the delays in vaccine availability had a substantial impact on the cost-effectiveness of vaccination.

[Clinical effectiveness and economical evaluation of preventive vaccination]

The value of mass vaccination as a preventive measure for infectious diseases is one of the most important advances of modern Medicine. The impact on incidence of several infectious diseases, until recently responsible for significant morbidity and mortality at world level, is well proved in a series of high quality epidemiological studies. In this scientific review we aimed firstly to briefly resume the history of mass vaccination and its scientists, responsible for synthesis and marketing of these drugs. In second place we present a group of a few disease preventable by vaccines as well as the Portuguese National Vaccination Plan and its benefits. In third place we identified groups of subjects in which a well structured vaccination plan is particularly important, as well as the correspondent diseases to be covered by vaccination. Fourthly, we discussed the ethical considerations of vaccination, and its tensions between subject autonomy and society advantages in com pulsive programs. Fifthly, we analyzed clinical effectiveness of vaccines through the concept of herd immunity, clinical evaluation of immune response to vaccines and some examples of systematic reviews on three relevant diseases (influenza, meningococcal and pneumococcal infections). In sixth place we discussed vaccine safety presenting monitoring methods of vaccination risks, as well as discussing the public myths concerning vaccines. Finally we present a economic analysis of preventive vaccination with a review of some published literature on specific diseases. We conclude that mass vaccination is a efficacious preventive measure, as well as a economic rational choice, and that this public health intervention should be a pillar of a modern preventive system.

Pharmacoeconomic evaluation of the MF59--adjuvanted influenza vaccine in the elderly population in Italy

INTRODUCTION

Influenza vaccination has proven effective in the reduction of influenza-like illness (ILI) cases and influenza-related hospitalizations, drug consumption, primary care consultations and deaths in the elderly population. The aim of this study is the assessment of the financial budget impact of a seasonal vaccination program based on the use of the MF59 adjuvanted vaccine as compared with the traditional vaccine or the absence of vaccination in Italian elderly population.

METHODS

A pharmacoeconomic simulation model was developed to simulate the effect of the three different vaccination programs during a single influenza season. Health economics and demographic data were taken from specific Italian sources, and vaccine effectiveness data derived from published literature. Direct medical costs were considered according to current Italian prices and tariffs.

RESULTS

About 83% of the 12 million people of at least 65 years of age currently resident in Italy can be considered at high risk for influenza complications due to underlying chronic diseases. Absence of vaccination could lead to more than 2 million ILl cases, and 29,000 related deaths. The vaccination program with a coverage rate of 65.6% would lead to an estimated 1.5 million ILl cases (26.9% reduction) with a standard vaccine and to 1.3 million (35.8% reduction) with the MF59 adjuvanted vaccine with a relative increase of avoided cases of 33,1%. The standard vaccination program produced a moderate direct cost increase of about 50 million Euro (+4.6%), whereas the adjuvanted vaccine provided an estimated saving of about 74 million Euro (-6.8%), both compared to the non vaccination. Cost savings were mainly related to hospital admissions avoided in the elderly population (>or=65 years of age).

CONCLUSIONS

The vaccination with the MF59 adjuvanted vaccine resulted more effective and cost saving when compared with the standard vaccination and with no vaccination, thus representing the optimal strategy for the elderly population. The standard vaccine, even though a light cost increase, still proved to be effective compared to the null option, with the initial cost for the vaccination program nearly offset by healthcare resources savings obtained during the season.

Influenza vaccination in healthy working adults in Russia: observational study of effectiveness and return on investment for the employer

BACKGROUND

All age groups are affected by influenza infection, resulting in significant medical and economic burden. Influenza infection of healthy working adults can have a marked effect on companies due to lost work days and reduced productivity. Studies in corporate settings have shown that vaccination programmes reduce this burden, although there is a lack of data in Eastern European countries.

OBJECTIVES

To determine the effectiveness of influenza vaccination in healthy working adults in Russia and the economic benefits of such a programme from an employer's perspective.

METHODS

In a prospective, non-randomized, non-placebo-controlled, observational study, healthy vaccinated and unvaccinated adults employed at the Russian Railways Public Corporation were followed for 8 months during the 2005-6 influenza season using questionnaires. A first questionnaire was administered at inclusion to collect general employee information; a second questionnaire was administered to collect data on post-vaccination adverse events; and monthly questionnaires were used to gather data on influenza-like illness (ILI). Effectiveness calculations and cost analyses were performed to evaluate the impact of the influenza vaccination programme on employee productivity and costs for the employer. The study vaccine used was the trivalent, inactivated, split vaccine Vaxigrip® (sanofi pasteur, France).

RESULTS

A total of 1331 employees volunteered for the study: 701 were vaccinated and 630 were not. The vaccine effectiveness was 70.4% against ILI events and 80.8% against sick leave days. Assuming that employees working with ILI symptoms had a reduced level of productivity (30-70% of normal), cost savings per vaccinated employee ranged from &U20AC;2.13 to &U20AC;5.43.

CONCLUSIONS

This study showed that an influenza vaccination programme significantly reduced ILI episodes and absenteeism, and may provide a positive return on investment for the employer.

Prevention of flu episodes with colostrum and Bifivir compared with vaccination: an epidemiological, registry study

The aim of this study was to evaluate the efficacy of colostrum (ARD Colostrum) in association with the immunomodulator Bifivir in the prevention of flu episodes compared with anti-flu vaccination. The registry groups included no prevention, vaccination, vaccination+immunomodulators, and immunomodulators only. Groups were comparable for age and sex distribution. In the group without prevention there were 8 major episodes and 12 minor episodes out of 34 subjects (8-12/34); in the vaccination group the respective figures were 8-13/38; in the group treated with a combination of vaccination and immunomodulators (ARD Colostrum + Bifivir) the figures were 4-9/33; and in the group treated with immunomodulators only there were 11 viral episodes (3-8) in 36 subjects. The episodes in the vaccination+immunomodulators and immunomodulators only groups were significantly lower compared with the other two groups (P<0.05). The number of episodes registered with the immunnomodulators was significantly lower than those observed in patients using vaccination or no prevention (P<0.05). The number of days of disease was higher in untreated controls compared to the groups treated with immunomodulators (P<0.05) and 2 times higher in the vaccination group compared to the same groups (P<0.05). The average relative costs were significantly lower (2.3 times) in the immunomodulators groups in comparison with the other groups (P<0.05). No problems concerning tolerability or side effects were observed during the study. Compliance was very good. In conclusion, the administration of immunomodulators is very cost effective and appears to be more effective than vaccination to prevent flu.

Effectiveness and cost-effectiveness of vaccination against pandemic influenza (H1N1) 2009

BACKGROUND

Decisions on the timing and extent of vaccination against pandemic (H1N1) 2009 virus are complex.

OBJECTIVE

To estimate the effectiveness and cost-effectiveness of pandemic influenza (H1N1) vaccination under different scenarios in October or November 2009.

DESIGN

Compartmental epidemic model in conjunction with a Markov model of disease progression.

DATA SOURCES

Literature and expert opinion.

TARGET POPULATION

Residents of a major U.S. metropolitan city with a population of 8.3 million.

TIME HORIZON

Lifetime.

PERSPECTIVE

Societal.

INTERVENTIONS

Vaccination in mid-October or mid-November 2009.

OUTCOME MEASURES

Infections and deaths averted, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness.

RESULTS OF BASE-CASE ANALYSIS

Assuming each primary infection causes 1.5 secondary infections, vaccinating 40% of the population in October or November would be cost-saving. Vaccination in October would avert 2051 deaths, gain 69 679 QALYs, and save $469 million compared with no vaccination; vaccination in November would avert 1468 deaths, gain 49 422 QALYs, and save $302 million.

RESULTS OF SENSITIVITY ANALYSIS

Vaccination is even more cost-saving if longer incubation periods, lower rates of infectiousness, or increased implementation of nonpharmaceutical interventions delay time to the peak of the pandemic. Vaccination saves fewer lives and is less cost-effective if the epidemic peaks earlier than mid-October.

LIMITATIONS

The model assumed homogenous mixing of case-patients and contacts; heterogeneous mixing would result in faster initial spread, followed by slower spread. Additional costs and savings not included in the model would make vaccination more cost-saving.

CONCLUSION

Earlier vaccination against pandemic (H1N1) 2009 prevents more deaths and is more cost-saving. Complete population coverage is not necessary to reduce the viral reproductive rate sufficiently to help shorten the pandemic.

PRIMARY FUNDING SOURCE

Agency for Healthcare Research and Quality and National Institute on Drug Abuse.

Cost-effectiveness of dual influenza and pneumococcal vaccination in 50-year-olds

Influenza vaccination is now recommended for all ages; CDC pneumococcal polysaccharide vaccination (PPV) recommendations are comorbidity-based in nonelderly patients. We constructed a Markov model to estimate the cost-effectiveness of dual influenza and pneumococcal vaccination in 50-year-olds. Patients were followed for 10 years, with differing time horizons examined in sensitivity analyses. With 100% vaccine uptake, dual vaccination cost $37,700/QALY gained compared to a CDC recommendation strategy; with observed vaccine uptake, dual vaccination cost $5,300/QALY. Results were sensitive to shorter time horizons, favoring CDC recommendations. We found dual vaccination of all 50-year-olds economically reasonable. Shorter duration models may not fully account for PPV effectiveness.