Economics of employer-sponsored workplace vaccination to prevent pandemic and seasonal influenza

Employers may be loath to fund vaccination programs without understanding the economic consequences. We developed a decision analytic computational simulation model including dynamic transmission elements that estimated the cost-benefit of employer-sponsored workplace vaccination from the employer's perspective. Implementing such programs was relatively inexpensive (<$35/vaccinated employee) and, in many cases, cost saving across diverse occupational groups in all seasonal influenza scenarios. Such programs were cost-saving for a 20% serologic attack rate pandemic scenario (range: -$15 to -$995) per vaccinated employee) and a 30% serologic attack rate pandemic scenario (range: -$39 to -$1,494 per vaccinated employee) across all age and major occupational groups.

Employees' willingness to pay to prevent influenza

OBJECTIVES

To quantify employees' preferences, as measured by willingness to pay, to prevent influenza in themselves and in their child and adult household members and to examine factors associated with willingness to pay.

STUDY DESIGN

Prospective observational cohort study of a convenience sample of employees from 3 large US employers. Participants had at least 1 child (< or = 17 years) living in their household for at least 4 days per week.

METHODS

Each month from November 2007 to April 2008, employees completed Web-based surveys regarding acute respiratory illness in their household. In the final survey, employees were presented with descriptions of influenza and questions regarding their willingness to pay to prevent influenza. Factors associated with willingness to pay were examined using multivariate ordinary least squares regression analysis of the log of willingness to pay.

RESULTS

Among 2006 employees, 31.3% were female, the mean age was 41.7 years, 85.3% were of white race/ethnicity, and the mean household size was 4.0. Employees' median (mean) willingness to pay to prevent influenza was $25 ($72) for themselves, $25 ($82) for their adult household members, and $50 ($142) (P <.01) for children. However, influenza vaccination rates were approximately equal for children (27.5%), employees (31.5%), and other adult household members (24.5%). This finding may be explained by barriers such as cost, dislike of vaccinations, and disagreement with national influenza vaccination recommendations, which were significantly associated with lower willingness to pay for prevention of influenza (P <.05).

CONCLUSION

Employees expressed a stronger preference to prevent influenza in their children than in themselves or other household members; however, modifiable barriers depress vaccination rates.

[Health economic impact of viral respiratory infections and pneumonia diseases on the elderly population in Poland]

Respiratory diseases and particularly those linked to pneumonia and influenza infections are a leading cause of serious illness. Streptococcus pneumoniae is responsible for 30 to 50% of all community-acquired pneumonia. It is also a common bacterial complication of influenza, especially in the frail populations, such as the elderly. There are scarce data reporting the medical and economic burden of these infections in Poland. Polish authorities recommend influenza and pneumococcal vaccinations for subjects aged 65 years and over but there is not public vaccination program in place for covering immunization. Elderly vaccination rates against influenza and pneumonia in Poland remain far below the World Health Organization's recommendations. THE AIMS OF THE STUDY: To assess the mean economic costs of influenza and pneumococcal diseases in the Polish elderly population, treated in outpatient and inpatient settings. Costs were estimated from the public payer and societal perspectives.

MATERIAL AND METHODS

Data were collected retrospectively from 2007 to 2009 in three different sites: a general practitioner Family clinic for outpatient data and two hospitals in Warsaw for inpatient data. Resource use linked to pneumonia orinfluenza treatments were collected from each site. Microcosting calculation method was used to estimate the outpatient costs. Inpatient costs were measured using the Ministry of Health patient's payment for each diagnosis group (DRG) but also using each subject's treatment inpatient costs added to the cost of hospital stay.

RESULTS

Mean outpatient cost for treating an outpatient was 101 PLN for influenza (1 euro = 4 PLN) and 186 PLN for community-acquired pneumonia. Mean total hospitalization cost including treatment cost and cost of stay was 7633 PLN among P&I patients whereas the DRG cost for this diagnosis was 1885 PLN. Similarly, the mean total inpatient cost was estimated to be 7162 PLN for Streptococcal bacteremia (DRG payment: 7140 PLN) and 4104 PLN for meningitis (DRG payment: 3804 PLN).

CONCLUSIONS

This study highlights the significant economic impact of influenza and pneumococcal diseases in the Polish population aged 65 years and over. Complications of influenza and pneumonia diseases contribute to weight down this burden as they often lead to hospitalizations in these frail populations. This first economic assessment is a 1st step in the measurement of the value of preventing these diseases through vaccination.

Modeling the economic impact of pandemic influenza: a case study in Turkey

Influenza pandemics have occurred intermittently throughout the 20th century and killed millions of people worldwide. It is expected that influenza pandemics will continue to occur in the near future. Huge number of deaths and cases is the most troublesome aspect of the influenza pandemics, but the other important trouble is the economic impact of the influenza pandemics to the countries. In this study, we try to detect the cost of a possible influenza pandemic under different scenarios and attack rates. We include the vaccination and antiviral treatment cost for direct cost and we add the work absenteeism cost to the calculations for indirect cost of influenza pandemics. As a case study, we calculate the economic impact of pandemic influenza for Turkey under three different scenarios and three different attack rates. Our optimistic estimation shows that the economic impact of pandemic influenza will be between 1.364 billion dollars and 2.687 billions dollars to Turkish economy depending on the vaccination strategies.

[Effectiveness of 23-valent penumococcal polysaccharide and split-virus influenza vaccines to prevent respiratory diseases for elderly people]

OBJECTIVE

To assess the effectiveness of 23-valent penumococcal polysaccharide vaccine (PenV23) and Split-Virus influenza vaccine (InfV-B) for preventing upper respiratory diseases in the aging population.

METHODS

151 people aged > or =60 years who inoculated the PenV23 and InfV-B vaccines at clinics during 2005 as trial group, and 188 people aged > or =65 years didn't administered as control guoup from some comminity. On base line survey, both guoups were followed up two years after vaccination about incidence, hospitalization rate, treatment and direct medical cost.

RESULTS

The vaccine of PenV23 and InfV-B vaccination in upper respiratory tract infection was 60% [(odds ratio OR) = 0.35, 95% CI (0.153-0.794)] and the difference between the 2 groups was significant (P = 0.009). The people had recevied both vaccines, the mean duration of hospitalization in vaccinated vs unvaccinated control peple was 20.00 days: 24.19 days (t = 5.82, P < 0.001). Benefit-cost ratio was 4.03, and the net benefit was Yen 177994.86.

CONCLUSION

Incidence of influenza-like illness for the elderly people in the community decreased by administered PenV23 ahd InfV-B vaccine. This vaccines had high cost-benefits.

Optimal pandemic influenza vaccine allocation strategies for the Canadian population

BACKGROUND

The world is currently confronting the first influenza pandemic of the 21(st) century. Influenza vaccination is an effective preventive measure, but the unique epidemiological features of swine-origin influenza A (H1N1) (pH1N1) introduce uncertainty as to the best strategy for prioritization of vaccine allocation. We sought to determine optimal prioritization of vaccine distribution among different age and risk groups within the Canadian population, to minimize influenza-attributable morbidity and mortality.

METHODOLOGY/PRINCIPAL FINDINGS

We developed a deterministic, age-structured compartmental model of influenza transmission, with key parameter values estimated from data collected during the initial phase of the epidemic in Ontario, Canada. We examined the effect of different vaccination strategies on attack rates, hospitalizations, intensive care unit admissions, and mortality. In all scenarios, prioritization of high-risk individuals (those with underlying chronic conditions and pregnant women), regardless of age, markedly decreased the frequency of severe outcomes. When individuals with underlying medical conditions were not prioritized and an age group-based approach was used, preferential vaccination of age groups at increased risk of severe outcomes following infection generally resulted in decreased mortality compared to targeting vaccine to age groups with higher transmission, at a cost of higher population-level attack rates. All simulations were sensitive to the timing of the epidemic peak in relation to vaccine availability, with vaccination having the greatest impact when it was implemented well in advance of the epidemic peak.

CONCLUSIONS/SIGNIFICANCE

Our model simulations suggest that vaccine should be allocated to high-risk groups, regardless of age, followed by age groups at increased risk of severe outcomes. Vaccination may significantly reduce influenza-attributable morbidity and mortality, but the benefits are dependent on epidemic dynamics, time for program roll-out, and vaccine uptake.

Economic appraisal of Ontario's Universal Influenza Immunization Program: a cost-utility analysis

BACKGROUND

In July 2000, the province of Ontario, Canada, initiated a universal influenza immunization program (UIIP) to provide free seasonal influenza vaccines for the entire population. This is the first large-scale program of its kind worldwide. The objective of this study was to conduct an economic appraisal of Ontario's UIIP compared to a targeted influenza immunization program (TIIP).

METHODS AND FINDINGS

A cost-utility analysis using Ontario health administrative data was performed. The study was informed by a companion ecological study comparing physician visits, emergency department visits, hospitalizations, and deaths between 1997 and 2004 in Ontario and nine other Canadian provinces offering targeted immunization programs. The relative change estimates from pre-2000 to post-2000 as observed in other provinces were applied to pre-UIIP Ontario event rates to calculate the expected number of events had Ontario continued to offer targeted immunization. Main outcome measures were quality-adjusted life years (QALYs), costs in 2006 Canadian dollars, and incremental cost-utility ratios (incremental cost per QALY gained). Program and other costs were drawn from Ontario sources. Utility weights were obtained from the literature. The incremental cost of the program per QALY gained was calculated from the health care payer perspective. Ontario's UIIP costs approximately twice as much as a targeted program but reduces influenza cases by 61% and mortality by 28%, saving an estimated 1,134 QALYs per season overall. Reducing influenza cases decreases health care services cost by 52%. Most cost savings can be attributed to hospitalizations avoided. The incremental cost-effectiveness ratio is Can$10,797/QALY gained. Results are most sensitive to immunization cost and number of deaths averted.

CONCLUSIONS

Universal immunization against seasonal influenza was estimated to be an economically attractive intervention.

Utility of virosomal adjuvated influenza vaccines: a review of the literature

In spite of the efforts of the World Health Organization (WHO), influenza continues to be a major public health problem, both because of its impact on the health of subjects at risk, such as the elderly, and because of the economic burden that it places on society. Adjuvants are agents which, when incorporated into vaccines, enhance the immunogenicity of their antigens. The need for ever more immunogenic and efficacious influenza vaccines has led to the development of innovative vaccines. One of these, the virosomal vaccine, has been on the market since 1997. The results obtained through controlled clinical studies and widespread application in the field suggest that the virosomal vaccine is not only an important tool for the prevention of seasonal influenza but also a valid means of potentiating the effect of a pandemic influenza vaccine and, perhaps, of preparing multivalent or combined vaccines.

Economics of influenza vaccine administration timing for children

OBJECTIVES

To determine how much should be invested each year to encourage and operationalize the administration of influenza vaccine to children before November and how late the vaccine should be offered each year.

STUDY DESIGN

Monte Carlo decision analytic computer simulation models.

METHODS

The children's influenza vaccination timing model quantified the incremental economic value of vaccinating a child earlier in the influenza season and the incremental cost of delaying vaccination. The children's monthly influenza vaccination decision model evaluated the cost-effectiveness of vaccinating versus not vaccinating for every month of the influenza season.

RESULTS

Getting children vaccinated by the end of October rather than when they are currently getting vaccinated could save society between $6.4 million and $9.2 million plus 653 and 926 quality-adjusted life-years (QALYs) and third-party payers between $4.1 million and $6.1 million plus 647 to 942 QALYs each year. Decision makers may want to continue offering influenza vaccination to children at least through the end of December. Vaccinating with trivalent inactivated virus vaccine was more cost-effective than vaccinating with live attenuated influenza vaccine for every month.

CONCLUSION

Policymakers could invest up to $6 million to $9 million a year to get children vaccinated in September or October without expending any net costs.

[Influenza vaccination of hospital healthcare staff from the perspective of the employer: a positive balance]

OBJECTIVE

To assess the annual productivity loss among hospital healthcare workers attributable to influenza and to estimate the costs and economic benefits of a vaccination programme from the perspective of the the employer.

DESIGN

Cost-benefit analysis.

METHODS

The percentage of work loss due to influenza was determined using monthly age and gender specific figures for productivity loss among healthcare workers of the University Medical Center Groningen (UMCG), the Netherlands over the period January 2006-June 2008. Influenza periods were determined on the basis of national surveillance data. The average increase in productivity loss in these periods was estimated by comparison with the periods outside influenza seasons. The direct costs of productivity loss from the perspective of the employer were estimated using the friction cost method. In the sensitivity analyses various modelling parameters were varied, such as the vaccination coverage.

RESULTS

In the UMCG, with approximately 9,400 employees, the estimated annual costs associated with productivity loss due to influenza before the introduction of the yearly influenza vaccination program were € 675,242 or on average, € 72 per employee. The economic benefits of the current vaccination program with a vaccination coverage of 24% with a vaccine effectiveness of 71% were estimated at € 89,858 or € 10 per employee. The nett economic benefits of a vaccination program with a target vaccination coverage of 70% with a vaccine effectiveness of 71% were estimated at € 244,325 or € 26 per employee.

CONCLUSION

This modelling study performed from the perspective of the employer showed that an annual influenza vaccination programme for hospital personnel can save costs.

Economic value of seasonal and pandemic influenza vaccination during pregnancy

BACKGROUND

The cost-effectiveness of maternal influenza immunization against laboratory-confirmed influenza has never been studied. The current 2009 H1N1 influenza pandemic provides a timely opportunity to perform such analyses. The study objective was to evaluate the cost-effectiveness of maternal influenza vaccination using both single- and 2-dose strategies against laboratory-confirmed influenza secondary to both seasonal epidemics and pandemic influenza outbreaks.

METHODS

A cost-effectiveness decision analytic model construct using epidemic and pandemic influenza characteristics from both the societal and third-party payor perspectives. A comparison was made between vaccinating all pregnant women in the United States versus not vaccinating pregnant women. Probabilistic (Monte Carlo) sensitivity analyses were also performed. The main outcome measures were incremental cost-effectiveness ratios (ICERs).

RESULTS

Maternal influenza vaccination using either the single- or 2-dose strategy is a cost-effective approach when influenza prevalence > or =7.5% and influenza-attributable mortality is > or =1.05% (consistent with epidemic strains). As the prevalence of influenza and/or the severity of the outbreak increases the incremental value of vaccination also increases. At a higher prevalence of influenza (> or =30%) the single-dose strategy demonstrates cost-savings while the 2-dose strategy remains highly cost-effective (ICER, < or =$6787.77 per quality-adjusted life year).

CONCLUSIONS

Maternal influenza immunization is a highly cost-effective intervention at disease rates and severity that correspond to both seasonal influenza epidemics and occasional pandemics. These findings justify ongoing efforts to optimize influenza vaccination during pregnancy from an economic perspective.

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 of universal influenza vaccination of children in pediatric practices

OBJECTIVES

The goals were to estimate nationally representative pediatric practices' costs of providing influenza vaccination during the 2006-2007 season and to simulate the costs pediatric practices might incur when implementing universal influenza vaccination for US children aged 6 months to 18 years.

METHODS

We surveyed a stratified, random sample of New York State pediatric practices (N = 91) to obtain information from physicians and office managers about all practice resources associated with provision of influenza vaccination. We estimated vaccination costs for 2 practice sizes (small and large) and 3 geographic areas (urban, suburban, and rural). We adjusted these data to obtain national estimates of the total practice cost (in 2006 dollars) for providing 1 influenza vaccination to children aged 6 months to 18 years.

RESULTS

Among all respondents, the median total cost per vaccination was $28.62 (interquartile range: $18.67-45.28). The median component costs were as follows: clinical personnel labor costs, $2.01; nonclinical personnel labor costs, $7.96; all other (overhead) costs, $10.43. Vaccine purchase costs averaged $8.22. Smaller practices and urban practices had higher costs than larger or suburban practices. With the assumption of vaccine administration reimbursement for all Vaccines for Children (VFC)-eligible children at the current Medicaid median of $8.40, the financial loss across all US pediatric practices through delivery of VFC vaccines would be $98 million if one third of children received influenza vaccine.

CONCLUSION

The total cost for pediatric practices to provide influenza vaccination is high, varies according to practice characteristics, and exceeds the average VFC reimbursement.

The timing of influenza vaccination for older adults (65 years and older)

While studies have found influenza vaccination to be cost-effective in older adults (65 years or older), they have not looked at how the vaccine's economic value may vary with the timing of vaccine administration. We developed a set of computer simulation models to evaluate the economic impact of vaccinating older adults at different months. Our models delineated the costs and utility losses in delaying vaccination past October and suggest that policy makers and payors may consider structuring incentives (< or =$2.50 per patient) to vaccinate in October. Our results also suggest that vaccination is still cost-effective through the end of February.