TY - JOUR
T1 - Cost-effectiveness of a recommendation of universal mass vaccination for seasonal influenza in the United States
AU - Clements, Karen M.
AU - Chancellor, Jeremy
AU - Nichol, Kristin
AU - Delong, Kelly
AU - Thompson, David
N1 - Funding Information:
Source of financial support: GlaxoSmithKline, Philadelphia PA.
PY - 2011/9
Y1 - 2011/9
N2 - 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, 517, 1849, 5064, 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 $15,900 per QALY gained, respectively, for UMV compared with TVP. Conclusions: UMV against seasonal influenza is cost saving in the United States under reasonable assumptions for coverage, cost, and efficacy.
AB - Objectives: We evaluated the cost-effectiveness of universal mass vaccination (UMV) against influenza compared with a targeted vaccine program (TVP) for selected age and risk groups in the United States. Methods: We modeled costs and outcomes of seasonal influenza with UMV and TVP, taking a societal perspective. The US population was stratified to model age-specific (< 5, 517, 1849, 5064, and 65+ years) vaccine coverage and efficacy. Probability of influenza-related illness (ILI) and complications, health-care utilization, costs, and survival were estimated. For a season's intervention, ILI cases in that year, lifetime costs (2008 US$), 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.
KW - cost-effectiveness analysis
KW - influenza vaccination
UR - http://www.scopus.com/inward/record.url?scp=80052782023&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=80052782023&partnerID=8YFLogxK
U2 - 10.1016/j.jval.2011.03.005
DO - 10.1016/j.jval.2011.03.005
M3 - Article
C2 - 21914499
AN - SCOPUS:80052782023
VL - 14
SP - 800
EP - 811
JO - Value in Health
JF - Value in Health
SN - 1098-3015
IS - 6
ER -