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Kim DeLuca E, Gebremariam A, Rose A, Biggerstaff M, Meltzer MI, Prosser LA. Cost-effectiveness of routine annual influenza vaccination by age and risk status. Vaccine 2023:S0264-410X(23)00495-4. [PMID: 37291022 DOI: 10.1016/j.vaccine.2023.04.069] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND The epidemiology of circulating seasonal influenza strains changed following the 2009 pandemic influenza A(H1N1). A universal influenza vaccination recommendation has been implemented and new vaccine types have become available post-2009. The objective of this study was to evaluate the cost-effectiveness of routine annual influenza vaccination in the context of this new evidence. METHODS A state transition simulation model was constructed to estimate the health and economic outcomes of influenza vaccination compared to no vaccination for hypothetical US cohorts stratified by age and risk status. Model input parameters were derived from multiple sources, including post-2009 vaccine effectiveness data from the US Flu Vaccine Effectiveness Network. The analysis used societal and healthcare sector perspectives and a one-year time horizon, except permanent outcomes were also included. The primary outcome was the incremental cost-effectiveness ratio (ICER) in dollars per quality-adjusted life years (QALYs) gained. RESULTS Compared to no vaccination, vaccination yielded ICERs lower than $95,000/QALY for all age and risk groups, except for non-high-risk adults 18-49 years ($194,000/QALY). Vaccination was cost-saving for adults ≥50 years at higher risk for influenza-related complications. Results were most sensitive to changes in the probability of influenza illness. Performing the analysis from the healthcare sector perspective, excluding vaccination time costs, delivering vaccinations in lower-cost settings, and including productivity losses improved the cost-effectiveness of vaccination. Sensitivity analysis revealed that vaccination remains below $100,000/QALY for older persons ≥65 years at vaccine effectiveness estimates as low as 4 %. CONCLUSIONS Cost-effectiveness of influenza vaccination varied by age and risk status and was less than $95,000/QALY for all subgroups, except for non-high-risk working-age adults. Results were sensitive to the probability of influenza illness and vaccination was more favorable under certain scenarios. Vaccination for higher risk subgroups resulted in ICERs below $100,000/QALY even at low levels of vaccine effectiveness or circulating virus.
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Affiliation(s)
- Ellen Kim DeLuca
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States; Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Acham Gebremariam
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Angela Rose
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Matthew Biggerstaff
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Martin I Meltzer
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Lisa A Prosser
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States; Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States.
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Comparative economic analysis of strategies for Japanese encephalitis vaccination of U.S. travelers. Vaccine 2020; 38:3351-3357. [PMID: 32169391 DOI: 10.1016/j.vaccine.2020.02.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 02/09/2020] [Accepted: 02/11/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Japanese encephalitis (JE) virus is the leading vaccine-preventable cause of encephalitis in Asia. For most travelers, JE risk is very low but varies based on several factors, including travel duration, location, and activities. To aid public health officials, health care providers, and travelers evaluate the worth of administering/ receiving pre-travel JE vaccinations, we estimated the numbers-needed-to-treat to prevent a case and the cost-effectiveness ratios of JE vaccination for U.S. travelers in different risk categories. METHODS We used a decision tree model to estimate cost per case averted from a societal and traveler perspective for hypothetical cohorts of vaccinated and unvaccinated travelers. Risk Category I included travelers planning to spend ≥1 month in JE-endemic areas, Risk Category II were shorter-term (<1 month) travelers spending ≥20% of their time doing outdoor activities in rural areas, and Risk Category III were all remaining travelers. We performed sensitivity analyses including examining changes in cost-effectiveness with 10- and 100-fold increases in incidence and medical treatment costs. RESULTS The numbers-needed-to-treat to prevent a case and cost per case averted were approximately 0.7 million and $0.6 billion for Risk Category I, 1.6 million and $1.2 billion for Risk Category II, and 9.8 million and $7.6 billion for Risk Category III. Increases of 10-fold and 100-fold in disease incidence proportionately decreased cost-effectiveness ratios. Similar levels of increases in medical treatment costs resulted in negligible changes in cost-effectiveness ratios. CONCLUSION Numbers-needed-to-treat and cost-effectiveness ratios associated with preventing JE cases in U.S. travelers by vaccination varied greatly by risk category and disease incidence. While cost effectiveness ratios are not the sole rationale for decision-making regarding JE vaccination, the results presented here can aid in making such decisions under very different risk and cost scenarios.
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Goodman RM, Bridges CB, Kim D, Pike J, Rose A, Prosser LA, Hutton DW. Billing and payment of commercial and Medicaid health plan adult vaccination claims in Michigan since the Affordable Care Act. Vaccine 2019; 37:6803-6813. [PMID: 31585724 DOI: 10.1016/j.vaccine.2019.09.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Provider concern regarding insurance non-payment for vaccines is a common barrier to provision of adult immunizations. We examined current adult vaccination billing and payment associated with two managed care populations to identify reasons for non-payment of immunization insurance claims. METHODS We assessed administrative data from 2014 to 2015 from Blue Care Network of Michigan, a nonprofit health maintenance organization, and Blue Cross Complete of Michigan, a Medicaid managed care plan, to determine rates of and reasons for non-payment of adult vaccination claims across patient-care settings, insurance plans, and vaccine types. We compared commercial and Medicaid payment rates to Medicare payment rates and examined patient cost sharing. RESULTS Pharmacy-submitted claims for adult vaccine doses were almost always paid (commercial 98.5%; Medicaid 100%). As the physician office accounted for the clear majority (79% commercial; 69% Medicaid) of medical (non-pharmacy) vaccination services, we limited further analyses of both commercial and Medicaid medical claims to the physician office setting. In the physician office setting, rates of payment were high with commercial rates of payment (97.9%) greater than Medicaid rates (91.6%). Reasons for non-payment varied, but generally related to the complexity of adult vaccine recommendations (patient diagnosis does not match recommendations) or insurance coverage (complex contracts, multiple insurance payers). Vaccine administration services were also generally paid. Commercial health plan payments were greater for both vaccine dose and vaccine administration than Medicare payments; Medicaid paid a higher amount for the vaccine dose, but less for vaccine administration than Medicare. Patients generally had very low (commercial) or no (Medicaid) cost-sharing for vaccination. CONCLUSIONS Adult vaccine dose claims were usually paid. Medicaid generally had higher rates of non-payment than commercial insurance.
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Affiliation(s)
- Robert M Goodman
- Blue Care Network/Blue Cross Blue Shield of Michigan, Southfield, MI, United States
| | - Carolyn B Bridges
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Immunization Services Division, Atlanta, GA, United States; Berry Technology Solutions, Inc., Peachtree City, GA, United States(1)
| | - David Kim
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Immunization Services Division, Atlanta, GA, United States
| | - Jamison Pike
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Immunization Services Division, Atlanta, GA, United States
| | - Angela Rose
- University of Michigan, Ann Arbor, MI, United States
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Shen A, Khavjou O, King G, Bates L, Zhou F, Leidner AJ, Yarnoff B. Provider time and costs to vaccinate adult patients: Impact of time counseling without vaccination. Vaccine 2019; 37:792-797. [PMID: 30639460 DOI: 10.1016/j.vaccine.2018.12.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/17/2018] [Accepted: 12/27/2018] [Indexed: 01/05/2023]
Abstract
Amid provider reports of financial barriers as an impediment to adult immunization, this study explores the time and costs of vaccination in adult provider practices. Both a Vaccination Time-Motion Study and Vaccine Practice Management Survey were conducted (March - October 2017) in a convenience sample of 19 family medicine (FM), internal medicine (IM), and obstetrician-gynecology (OBGYN) practices, in nine states. Practices were directly observed during a one week period; estimates were collected of time spent on activities that could not be directly observed. Cost estimates were calculated by converting staff time for performed activities. In the time-motion study, FM and IM practices spent similar time conducting vaccination activities (median = 5 min per vaccination), while OBGYN practices spent more time (median = 29 min per vaccination). Combining results from the time-motion study and the practice management survey, the median costs of vaccination remained similar for FM practices and IM practices at $7 and $8 per vaccination, respectively, but was substantially higher for OBGYN practices at $43 per vaccination. Factors that contributed to higher costs among OBGYN practices were the increased time to counsel patients, administer vaccines, and to plan and manage vaccine supplies. In addition, 68% of OBGYN patients who were offered and counseled to receive vaccines declined to receive them. Counseling patients who ultimately do not go on to receive a vaccine may be an important cost factor. Lower costs of vaccination services may be achieved by increasing efficiencies in workflow or the volume of vaccinations.
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Affiliation(s)
- Angela Shen
- National Vaccine Program Office, Office of the Assistant Secretary for Health, US Department of Health and Human Services, Washington, DC, United States
| | | | - Grant King
- RTI International, Raleigh, NC, United States
| | | | - Fangjun Zhou
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Does cost-effectiveness of influenza vaccine choice vary across the U.S.? An agent-based modeling study. Vaccine 2017; 35:3974-3981. [PMID: 28606814 DOI: 10.1016/j.vaccine.2017.05.093] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 04/26/2017] [Accepted: 05/31/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND In a prior agent-based modeling study, offering a choice of influenza vaccine type was shown to be cost-effective when the simulated population represented the large, Washington DC metropolitan area. This study calculated the public health impact and cost-effectiveness of the same four strategies: No Choice, Pediatric Choice, Adult Choice, or Choice for Both Age Groups in five United States (U.S.) counties selected to represent extremes in population age distribution. METHODS The choice offered was either inactivated influenza vaccine delivered intramuscularly with a needle (IIV-IM) or an age-appropriate needle-sparing vaccine, specifically, the nasal spray (LAIV) or intradermal (IIV-ID) delivery system. Using agent-based modeling, individuals were simulated as they interacted with others, and influenza was tracked as it spread through each population. Influenza vaccination coverage derived from Centers for Disease Control and Prevention (CDC) data, was increased by 6.5% (range 3.25%-11.25%) to reflect the effects of vaccine choice. RESULTS Assuming moderate influenza infectivity, the number of averted cases was highest for the Choice for Both Age Groups in all five counties despite differing demographic profiles. In a cost-effectiveness analysis, Choice for Both Age Groups was the dominant strategy. Sensitivity analyses varying influenza infectivity, costs, and degrees of vaccine coverage increase due to choice, supported the base case findings. CONCLUSION Offering a choice to receive a needle-sparing influenza vaccine has the potential to significantly reduce influenza disease burden and to be cost saving. Consistent findings across diverse populations confirmed these findings.
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Epidemiological and economic impact of pandemic influenza in Chicago: Priorities for vaccine interventions. PLoS Comput Biol 2017; 13:e1005521. [PMID: 28570660 PMCID: PMC5453424 DOI: 10.1371/journal.pcbi.1005521] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 04/14/2017] [Indexed: 11/19/2022] Open
Abstract
The study objective is to estimate the epidemiological and economic impact of vaccine interventions during influenza pandemics in Chicago, and assist in vaccine intervention priorities. Scenarios of delay in vaccine introduction with limited vaccine efficacy and limited supplies are not unlikely in future influenza pandemics, as in the 2009 H1N1 influenza pandemic. We simulated influenza pandemics in Chicago using agent-based transmission dynamic modeling. Population was distributed among high-risk and non-high risk among 0–19, 20–64 and 65+ years subpopulations. Different attack rate scenarios for catastrophic (30.15%), strong (21.96%), and moderate (11.73%) influenza pandemics were compared against vaccine intervention scenarios, at 40% coverage, 40% efficacy, and unit cost of $28.62. Sensitivity analysis for vaccine compliance, vaccine efficacy and vaccine start date was also conducted. Vaccine prioritization criteria include risk of death, total deaths, net benefits, and return on investment. The risk of death is the highest among the high-risk 65+ years subpopulation in the catastrophic influenza pandemic, and highest among the high-risk 0–19 years subpopulation in the strong and moderate influenza pandemics. The proportion of total deaths and net benefits are the highest among the high-risk 20–64 years subpopulation in the catastrophic, strong and moderate influenza pandemics. The return on investment is the highest in the high-risk 0–19 years subpopulation in the catastrophic, strong and moderate influenza pandemics. Based on risk of death and return on investment, high-risk groups of the three age group subpopulations can be prioritized for vaccination, and the vaccine interventions are cost saving for all age and risk groups. The attack rates among the children are higher than among the adults and seniors in the catastrophic, strong, and moderate influenza pandemic scenarios, due to their larger social contact network and homophilous interactions in school. Based on return on investment and higher attack rates among children, we recommend prioritizing children (0–19 years) and seniors (65+ years) after high-risk groups for influenza vaccination during times of limited vaccine supplies. Based on risk of death, we recommend prioritizing seniors (65+ years) after high-risk groups for influenza vaccination during times of limited vaccine supplies. The study objective is to estimate the epidemiological and economic impact of vaccine interventions during an influenza pandemic in Chicago, to assist in vaccine intervention priorities. Population dynamics play an important role in influenza pandemic planning and response. To optimally allocate limited vaccine resources, it is important to inform decision makers and public health officials about both the direct benefit among vaccinated population and the indirect benefit among non-vaccinated population. This study adds to the evidence of prior studies by using a detailed agent-based model for estimating the direct and indirect benefits of epidemiological and economic impact of vaccine-based interventions. This study can be extended to analyze for a range of vaccine compliance and efficacy values at different attack rates of influenza pandemics in different rural and urban areas of the United States and at the country level, to infer objective prioritization criteria for influenza vaccine interventions among different risk and age groups.
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Lee BY, Bartsch SM, Mvundura M, Jarrahian C, Zapf KM, Marinan K, Wateska AR, Snyder B, Swaminathan S, Jacoby E, Norman JJ, Prausnitz MR, Zehrung D. An economic model assessing the value of microneedle patch delivery of the seasonal influenza vaccine. Vaccine 2015; 33:4727-36. [PMID: 25772675 PMCID: PMC4623320 DOI: 10.1016/j.vaccine.2015.02.076] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 01/06/2015] [Accepted: 02/16/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND New vaccine technologies may improve the acceptability, delivery (potentially enabling self-administration), and product efficacy of influenza vaccines. One such technology is the microneedle patch (MNP), a skin delivery technology currently in development. Although MNPs hold promise in preclinical studies, their potential economic and epidemiologic impacts have not yet been evaluated. METHODS We utilized a susceptible-exposed-infectious-recovered (SEIR) transmission model linked to an economic influenza outcomes model to assess the economic value of introducing the MNP into the current influenza vaccine market in the United States from the third-party payer and societal perspectives. We also explored the impact of different vaccination settings, self-administration, the MNP price, vaccine efficacy, compliance, and MNP market share. Outcomes included costs, quality-adjusted life years (QALYs), cases, and incremental cost-effectiveness ratios (ICERs; cost/QALY). RESULTS With healthcare provider administration, MNP introduction would be cost-effective (ICERs ≤$23,347/QALY) at all MNP price points ($9.50-$30) and market shares (10-60%) assessed, except when compliance and efficacy were assumed to be the same as existing vaccines and the MNP occupied a 10% market share. If MNP self-administration were available (assuming the same efficacy as current technologies), MNP compliance or its efficacy would need to increase by ≥3% in order to be cost-effective (ICERs ≤$1401/QALY), assuming a 2% reduction in administration success with unsupervised self-administration. Under these conditions, MNP introduction would be cost-effective for all price points and market shares assessed. CONCLUSIONS When healthcare providers administered the MNP, its introduction would be cost-effective or dominant (i.e., less costly and more effective) in the majority of scenarios assessed. If self-administration were available, MNP introduction would be cost-effective if it increased compliance enough to overcome any decrease in self-administration success or if the MNP presentation afforded an increase in efficacy over current delivery methods for influenza vaccines.
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Affiliation(s)
- Bruce Y Lee
- Johns Hopkins Bloomberg School of Public Health, 855 N Wolfe Street, Suite 600, Baltimore, MD 21205, United States.
| | - Sarah M Bartsch
- Johns Hopkins Bloomberg School of Public Health, 855 N Wolfe Street, Suite 600, Baltimore, MD 21205, United States
| | - Mercy Mvundura
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, United States
| | | | - Kristina M Zapf
- Johns Hopkins Bloomberg School of Public Health, 855 N Wolfe Street, Suite 600, Baltimore, MD 21205, United States
| | - Kathleen Marinan
- Johns Hopkins Bloomberg School of Public Health, 855 N Wolfe Street, Suite 600, Baltimore, MD 21205, United States
| | - Angela R Wateska
- Johns Hopkins Bloomberg School of Public Health, 855 N Wolfe Street, Suite 600, Baltimore, MD 21205, United States
| | - Bill Snyder
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, United States
| | | | - Erica Jacoby
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, United States
| | - James J Norman
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, 311 Ferst Drive, Atlanta, GA 30332, United States
| | - Mark R Prausnitz
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, 311 Ferst Drive, Atlanta, GA 30332, United States
| | - Darin Zehrung
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, United States
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Net Costs Due to Seasonal Influenza Vaccination--United States, 2005-2009. PLoS One 2015; 10:e0132922. [PMID: 26230271 PMCID: PMC4521706 DOI: 10.1371/journal.pone.0132922] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 06/22/2015] [Indexed: 11/19/2022] Open
Abstract
Background Seasonal influenza causes considerable morbidity and mortality across all age groups, and influenza vaccination was recommended in 2010 for all persons aged 6 months and above. We estimated the averted costs due to influenza vaccination, taking into account the seasonal economic burden of the disease. Methods We used recently published values for averted outcomes due to influenza vaccination for influenza seasons 2005-06, 2006-07, 2007-08, and 2008-09, and age cohorts 6 months-4 years, 5-19 years, 20-64 years, and 65 years and above. Costs were calculated according to a payer and societal perspective (in 2009 US$), and took into account medical costs and productivity losses. Results When taking into account direct medical costs (payer perspective), influenza vaccination was cost saving only for the older age group (65≥) in seasons 2005-06 and 2007-08. Using the same perspective, influenza vaccination resulted in total costs of $US 1.7 billion (95%CI: $US 0.3–4.0 billion) in 2006-07 and $US 1.8 billion (95%CI: $US 0.1–4.1 billion) in 2008-09. When taking into account a societal perspective (and including the averted lost earnings due to premature death) averted deaths in the older age group influenced the results, resulting in cost savings for all ages combined in season 07-08. Discussion Influenza vaccination was cost saving in the older age group (65≥) when taking into account productivity losses and, in some seasons, when taking into account medical costs only. Averted costs vary significantly per season; however, in seasons where the averted burden of deaths is high in the older age group, averted productivity losses due to premature death tilt overall seasonal results towards savings. Indirect vaccination effects and the possibility of diminished case severity due to influenza vaccination were not considered, thus the averted burden due to influenza vaccine may be even greater than reported.
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The National Vaccine Advisory Committee: reducing patient and provider barriers to maternal immunizations: approved by the National Vaccine Advisory Committee on June 11, 2014. Public Health Rep 2015; 130:10-42. [PMID: 25552752 PMCID: PMC4245282 DOI: 10.1177/003335491513000104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
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Adachi K, Coleman MS, de la Motte Hurst C, Vargas ML, Oladele A, Weinberg MS. Costs of, and reimbursement for, vaccines: A case study at the Board of Health Refugee Services in DeKalb county, Georgia. Vaccine 2013; 31:2317-22. [DOI: 10.1016/j.vaccine.2012.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 07/25/2012] [Accepted: 08/08/2012] [Indexed: 11/26/2022]
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A tool for the economic analysis of mass prophylaxis operations with an application to H1N1 influenza vaccination clinics. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2013; 17:E22-8. [PMID: 21135651 DOI: 10.1097/phh.0b013e3181f87952] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article uses the 2009 H1N1 influenza vaccination program experience to introduce a cost analysis approach that may be relevant for planning mass prophylaxis operations, such as vaccination clinics at public health centers, work sites, schools, or pharmacy-based clinics. These costs are important for planning mass influenza vaccination activities and are relevant for all public health emergency preparedness scenarios requiring countermeasure dispensing. We demonstrate how costs vary depending on accounting perspective, staffing composition, and other factors. We also describe a mass vaccination clinic budgeting tool that clinic managers may use to estimate clinic costs and to examine how costs vary depending on the availability of volunteers or donated supplies and on the number of patients vaccinated per hour. Results from pilot tests with school-based H1N1 influenza vaccination clinic managers are described. The tool can also contribute to planning efforts for universal seasonal influenza vaccination.
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Fontanesi J, Jue-Leong S. Logistical and fiscal sustainability of a school-based, pharmacist-administered influenza vaccination program. J Am Pharm Assoc (2003) 2012; 52:e74-9. [DOI: 10.1331/japha.2012.10113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Mahamud A, Fiebelkorn AP, Nelson G, Aguon A, McKenna J, Villarruel G, Gallagher K, Ortega-Sánchez IR. Economic impact of the 2009-2010 Guam mumps outbreak on the public health sector and affected families. Vaccine 2012; 30:6444-8. [PMID: 22902678 DOI: 10.1016/j.vaccine.2012.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 07/30/2012] [Accepted: 08/01/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND The United States Territory of Guam reported a large mumps outbreak of 505 cases during 2009-2010. We assessed the economic impact of the outbreak from the perspectives of the local public health sector and affected families. METHODS Using standard cost analysis methods, we retrospectively identified all public health personnel involved in the outbreak response and surveyed them about their outbreak-related activities. We then estimated the costs of outbreak-related personnel hours and materials. We also assessed out-of-pocket costs and costs incurred for work-time missed for persons with mumps and their families. We defined the analysis period as February 25-October 22, 2010. RESULTS Seventy-six public health personnel were involved in outbreak response activities. Overall, the response required approximately 8264 person-hours, 2380 miles driven, and 3000 doses of measles-mumps-rubella vaccine ordered. The cost to the public health sector was 256,785 U.S. dollars (USD). Families of 102 persons with mumps were interviewed. An estimated 761 USD per person with mumps was spent by families; 88% of this cost was due to missed days of work. The estimated total cost to families of the 470 persons with mumps during the analysis period was 357,670 USD. Total outbreak-related costs were 614,455 USD. CONCLUSIONS The costs reported underscore the impact of mumps outbreaks in highly vaccinated populations and the need for effective mumps prevention and control strategies.
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Affiliation(s)
- Abdirahman Mahamud
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, United States.
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A pathway to leadership for adult immunization: recommendations of the National Vaccine Advisory Committee: approved by the National Vaccine Advisory Committee on June 14, 2011. Public Health Rep 2012; 127 Suppl 1:1-42. [PMID: 22210957 PMCID: PMC3235599 DOI: 10.1177/00333549121270s101] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Prosser LA, Lavelle TA, Fiore AE, Bridges CB, Reed C, Jain S, Dunham KM, Meltzer MI. Cost-effectiveness of 2009 pandemic influenza A(H1N1) vaccination in the United States. PLoS One 2011; 6:e22308. [PMID: 21829456 PMCID: PMC3146485 DOI: 10.1371/journal.pone.0022308] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 06/23/2011] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Lisa A Prosser
- Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan Health System, Ann Arbor, Michigan, United States of America.
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Yoo BK, Szilagyi PG, Schaffer SJ, Humiston SG, Rand CM, Albertin CS, Vincelli P, Blumkin AK, Shone LP, Coleman MS. Cost of universal influenza vaccination of children in pediatric practices. Pediatrics 2009; 124 Suppl 5:S499-506. [PMID: 19948581 PMCID: PMC2936456 DOI: 10.1542/peds.2009-1542i] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Byung-Kwang Yoo
- University of Rochester, School of Medicine and Dentistry, Division of Health Policy and Outcomes Research, Department of Community and Preventive Medicine, 601 Elmwood Ave, Box 644, Rochester, NY 14642, USA.
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Muzumdar JM, Cline RR. Vaccine supply, demand, and policy: a primer. J Am Pharm Assoc (2003) 2009; 49:e87-99. [PMID: 19589753 PMCID: PMC7185851 DOI: 10.1331/japha.2009.09007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Revised: 06/17/2009] [Accepted: 06/17/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To provide an overview of supply and demand issues in the vaccine industry and the policy options that have been implemented to resolve these issues. DATA SOURCES Medline, Policy File, and International Pharmaceutical Abstracts were searched to locate academic journal articles. Other sources reviewed included texts on the topics of vaccine history and policy, government agency reports, and reports from independent think tanks. Keywords included vaccines, immunizations, supply, demand, and policy. STUDY SELECTION Search criteria were limited to English language and human studies. Articles pertaining to vaccine demand, supply, and public policy were selected and reviewed for inclusion. DATA EXTRACTION By the authors. DATA SYNTHESIS Vaccines are biologic medications, therefore making their development and production more difficult and costly compared with "small-molecule" drugs. Research and development costs for vaccines can exceed $800 million, and development may require 10 years or more. Strict manufacturing regulations and facility upgrades add to these costs. Policy options to increase and stabilize the supply of vaccines include those aimed at increasing supply, such as government subsidies for basic vaccine research, liability protection for manufacturers, and fast-track approval for new vaccines. Options to increase vaccine demand include advance purchase commitments, government stockpiles, and government financing for select populations. CONCLUSION High development costs and multiple barriers to entry have led to a decline in the number of vaccine manufacturers. Although a number of vaccine policies have met with mixed success in increasing the supply of and demand for vaccines, a variety of concerns remain, including developing vaccines for complex pathogens and increasing immunization rates with available vaccines. New policy innovations such as advance market commitments and Medicare Part D vaccine coverage have been implemented and may aid in resolving some of the problems in the vaccine industry.
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Affiliation(s)
- Jagannath M Muzumdar
- Social and Administrative Pharmacy, College of Pharmacy, University of Minnesota, Minneapolis 55455, USA..
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Prosser LA, O'Brien MA, Molinari NAM, Hohman KH, Nichol KL, Messonnier ML, Lieu TA. Non-traditional settings for influenza vaccination of adults: costs and cost effectiveness. PHARMACOECONOMICS 2008; 26:163-78. [PMID: 18198935 DOI: 10.2165/00019053-200826020-00006] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Influenza vaccination rates remain far below national goals in the US. Expanding influenza vaccination in non-traditional settings such as worksites and pharmacies may be a way to enhance vaccination coverage for adults, but scant data exist on the cost effectiveness of this strategy. The aims of this study were to (i) describe the costs of vaccination in non-traditional settings such as pharmacies and mass vaccination clinics; and (ii) evaluate the projected health benefits, costs and cost effectiveness of delivering influenza vaccination to adults of varying ages and risk groups in non-traditional settings compared with scheduled doctor's office visits. All analyses are from the US societal perspective. METHODS We evaluated the costs of influenza vaccination in non-traditional settings via detailed telephone interviews with representatives of organizations that conduct mass vaccination clinics and pharmacies that use pharmacists to deliver vaccinations. Next, we constructed a decision tree to compare the projected health benefits and costs of influenza vaccination delivered via non-traditional settings or during scheduled doctor's office visits with no vaccination. The target population was stratified by age (18-49, 50-64 and >or=65 years) and risk status (high or low risk for influenza-related complications). Probabilities and costs (direct and opportunity) for uncomplicated influenza illness, outpatient visits, hospitalizations, deaths, vaccination and vaccine adverse events were derived from primary data and from published and unpublished sources. RESULTS The mean cost (year 2004 values) of vaccination was lower in mass vaccination (dollars US 17.04) and pharmacy (dollars US 11.57) settings than in scheduled doctor's office visits (dollars US 28.67). Vaccination in non-traditional settings was projected to be cost saving for healthy adults aged >or=50 years, and for high-risk adults of all ages. For healthy adults aged 18-49 years, preventing an episode of influenza would cost dollars US 90 if vaccination were delivered via the pharmacy setting, dollars US 210 via the mass vaccination setting and dollars US 870 via a scheduled doctor's office visit. Results were sensitive to assumptions on the incidence of influenza illness, the costs of vaccination (including recipient time costs) and vaccine effectiveness. CONCLUSION Using non-traditional settings to deliver routine influenza vaccination to adults is likely to be cost saving for healthy adults aged 50-64 years and relatively cost effective for healthy adults aged 18-49 years when preferences for averted morbidity are included.
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Affiliation(s)
- Lisa A Prosser
- Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts 02215, USA.
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Helms CM, Guerra FA, Klein JO, Schaffner W, Arvin AM, Peter G. Strengthening the nation's influenza vaccination system: a National Vaccine Advisory Committee assessment. Am J Prev Med 2005; 29:221-6. [PMID: 16168873 DOI: 10.1016/j.amepre.2005.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2005] [Revised: 04/06/2005] [Accepted: 05/31/2005] [Indexed: 11/20/2022]
Affiliation(s)
- Charles M Helms
- National Vaccine Advisory Committee, Department of Health and Human Services, Washington DC, USA.
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Lieu TA, McGuire TG, Hinman AR. Overcoming Economic Barriers To The Optimal Use Of Vaccines. Health Aff (Millwood) 2005; 24:666-79. [PMID: 15886158 DOI: 10.1377/hlthaff.24.3.666] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Vaccines are among the most cost-effective interventions in health care, but economic factors may interfere with their optimal development and delivery in both industrialized and developing countries. For the United States, making the best use of available vaccines will require increasing the financing for vaccines via the public and private systems. For developing countries, innovative and promising approaches include pull mechanisms to establish predictable demand and push mechanisms such as targeted development programs. Partnerships between philanthropy and public resources have made progress in addressing gaps in vaccine financing and development for developing countries, but much remains to be done.
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Affiliation(s)
- Tracy A Lieu
- Harvard Pilgrim Health Care and Harvard Medical School, Boston, Massachusetts, USA.
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