# 4475
Influenza epidemics each year inflict a heavy toll around the world, in terms of lives lost and human suffering, and in purely economic terms as well.
The numbers are estimates of course, but as many as 500,000 lives are believed lost in a `normal’ influenza year. Millions more are hospitalized, and so the economic burden of the disease is heavy.
Ontario, Canada (pop. 13 million) was the first region in the world to begin offering `universal’ flu vaccinations, beginning back in 2000.
Not everyone avails themselves of the shot, of course. But unlike the rest of the world, all those under the age of 65 have been encouraged to get the shot.
After ten years, we now have some comparative data showing the impact, and relative costs, of Universal Influenza Immunization Programs (UIIPs) vs. Targeted Influenza Immunizations Programs (TIIPs).
These numbers are, by necessity, estimates. There is simply no practical way to count every influenza case, or identify every influenza-related death.
Still . . . with years of data to examine, the trends reported in this study appear to support the notion of offering universal flu vaccinations.
First, some excerpts from the press release then a look at the PLoS study’s abstract.
Public release date: 6-Apr-2010
Ontario's universal flu vaccination plan
The millions of dollars invested by the province of Ontario in its universal flu vaccine campaign saves lives and is a sensible investment, according to an economic analysis by a researcher at the University of Toronto and the University Health Network.
Even though the estimated $40 million annual cost of Ontario's flu vaccine campaign is double the price tag of a vaccination campaign targeted to specific populations, the universal campaign remains "economically attractive," said Beate Sander, a doctoral student at the University of Toronto Faculty of Medicine's Department of Health Policy, Management & Evaluation and a researcher at the University Health Network's Division of Clinical Decision-Making and Health Care Research.
"Compared to a targeted influenza immunization program, the universal program reduces influenza illness attack rates, morbidity and mortality at reasonable cost to the taxpayer," said Sander, also of the Toronto Health Economics and Technology Assessment Collaborative. The study by Sanders and her colleagues was published today in the journal PloS Medicine.
<SNIP>
Among the findings of Sander and her colleagues:
- Estimated number of influenza cases prevented each season: 34,541 (61% of all cases each season)
- Estimated number of influenza deaths prevented each season: 111 (28% reduction in mortality)
- Estimated number of influenza-related hospitalizations prevented each season: 786 (46% reduction)
- Estimated number of Emergency Department visits prevented each season: 7,745 (61% reduction)
- Estimated number of doctor office visits prevented each season: 30,306 (61% reduction)
As this is a PLoS Medicine study, it is freely available online. I’ve reparagraphed the Method and Findings section for easier readability.
Follow the link to read it in its entirety.
Economic Appraisal of Ontario's Universal Influenza Immunization Program: A Cost-Utility Analysis
Citation: Sander B, Kwong JC, Bauch CT, Maetzel A, McGeer A, et al. (2010) Economic Appraisal of Ontario's Universal Influenza Immunization Program: A Cost-Utility Analysis. PLoS Med 7(4): e1000256. doi:10.1371/journal.pmed.1000256
Abstract
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.
Please see later in the article for the Editors' Summary
