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.
: Please see later in the article for the Editors' Summary
Vyšlo v časopise:
Economic Appraisal of Ontario's Universal Influenza Immunization Program: A Cost-Utility Analysis. PLoS Med 7(4): e32767. doi:10.1371/journal.pmed.1000256
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pmed.1000256
Souhrn
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
Zdroje
1. 2003 Influenza. Fact Sheet: World Health Organization
2. JeffersonTO
RivettiD
Di PietrantonjC
RivettiA
DemicheliV
2007 Vaccines for preventing influenza in healthy adults. Cochrane Database Syst Rev. CD001269 p
3. GovaertTM
ThijsCT
MasurelN
SprengerMJ
DinantGJ
1994 The efficacy of influenza vaccination in elderly individuals. A randomized double-blind placebo-controlled trial. JAMA 272 1661 1665
4. NeuzilKM
DupontWD
WrightPF
EdwardsKM
2001 Efficacy of inactivated and cold-adapted vaccines against influenza A infection, 1985 to 1990: the pediatric experience. Pediatr Infect Dis J 20 733 740
5. HeikkinenT
RuuskanenO
WarisM
ZieglerT
ArolaM
1991 Influenza vaccination in the prevention of acute otitis media in children. Am J Dis Child 145 445 448
6. ClementsDA
LangdonL
BlandC
WalterE
1995 Influenza A vaccine decreases the incidence of otitis media in 6- to 30-month-old children in day care. Arch Pediatr Adolesc Med 149 1113 1117
7. ColomboC
ArgiolasL
La VecchiaC
NegriE
MeloniG
2001 Influenza vaccine in healthy preschool children. Rev Epidemiol Sante Publique 49 157 162
8. 2008 Statement on influenza vaccination for the 2008–2009 season. An Advisory Committee Statement (ACS). Can Commun Dis Rep 34 1 46
9. 1993 Canadian Consensus Conference on Influenza. Can Commun Dis Rep 19 136 142, 145–137
10. SquiresSG
PelletierL
2000 Publicly-funded influenza and pneumococcal immunization programs in Canada: a progress report. Can Commun Dis Rep 26 141 148
11. FioreAE
ShayDK
BroderK
IskanderJK
UyekiTM
2008 Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008. MMWR Recomm Rep 57 1 60
12. 2000 Ontario invests $38 million to ease emergency room pressures with universal vaccination program. Ministry of Health and Long-Term Care.
13. KwongJC
StukelTA
LimJ
McGeerAJ
UpshurRE
2008 The effect of universal influenza immunization on mortality and health care use. PLoS Med 5 e211 doi:10.1371/journal.pmed.0050211
14. MoranK
MaatenS
GuttmannA
NorthrupD
KwongJC
2009 Influenza vaccination rates in Ontario children: implications for universal childhood vaccination policy. Vaccine
15. JuurlinkDN
StukelTA
KwongJ
KoppA
McGeerA
2006 Guillain-Barre syndrome after influenza vaccination in adults: a population-based study. Arch Intern Med 166 2217 2221
16. TurnerD
WailooA
NicholsonK
CooperN
SuttonA
2003 Systematic review and economic decision modelling for the prevention and treatment of influenza A and B. Health Technol Assess 7 iii iv, xi–xiii, 1–170
17. ReisingerK
GreeneG
AultmanR
SanderB
GyldmarkM
2004 Effect of influenza treatment with oseltamivir on health outcome and costs in otherwise healthy children. Clin Drug Investig 24 395 407
18. KwongJC
StukelTA
McGeerAJ
ManuelDG
2007 Appropriate measures of influenza immunization program effectiveness. Vaccine 25 967 969
19. 2008 Mortality rate per 1,000 population. Canadian socio-economic information management system (CANSIM) Statistics Canada et al.
20. MittmannN
TrakasK
RisebroughN
LiuBA
1999 Utility scores for chronic conditions in a community-dwelling population. PharmacoEconomics 15 369 376
21. 2006 HTA guidelines for the economic evaluation of health technologies. Ottawa.
22. 2008 Consumer price index (CPI), Ontario, Health Care, 1979–2007. Canadian socio-economic information management system (CANSIM) Statistics Canada et al.
23. 2008 JPPC Rate Model results based on 2006/07 data. Ontario Joint Policy and Planning Committee
24. PinkGH
BolleyHB
1994 Physicians in health care management: 4. Case mix groups and resource intensity weights: physicians and hospital funding. CMAJ 150 1255 1261
25. PinkGH
BolleyHB
1994 Physicians in health care management: 3. Case mix groups and resource intensity weights: an overview for physicians. CMAJ 150 889 894
26. OCCI (Ontario Case Costing Initiative) 2009 Costing analysis tool.
27. JeffersonT
RivettiA
HarndenA
Di PietrantonjC
DemicheliV
2008 Vaccines for preventing influenza in healthy children. Cochrane Database Syst Rev. CD004879
28. RivettiD
JeffersonT
ThomasR
RudinM
RivettiA
2006 Vaccines for preventing influenza in the elderly. Cochrane Database Syst Rev 3 CD004876
29. EspositoS
MarchisioP
BosisS
LambertiniL
ClautL
2006 Clinical and economic impact of influenza vaccination on healthy children aged 2–5 years. Vaccine 24 629 635
30. HibbertCL
PiedraPA
McLaurinKK
VesikariT
MauskopfJ
2007 Cost-effectiveness of live-attenuated influenza vaccine, trivalent in preventing influenza in young children attending day-care centres. Vaccine 25 8010 8020
31. LiS
LeaderS
2007 Economic burden and absenteeism from influenza-like illness in healthy households with children (5–17 years) in the US. Respiratory Medicine 101 1244 1250
32. MarchettiM
KuhnelUM
ColomboGL
EspositoS
PrincipiN
2007 Cost-effectiveness of adjuvanted influenza vaccination of healthy children 6 to 60 months of age. Human Vaccines 3 14 22
33. NavasE
SallerasL
DominguezA
IbanezD
PratA
2007 Cost-effectiveness analysis of inactivated virosomal subunit influenza vaccination in children aged 3–14 years from the provider and societal perspectives. Vaccine 25 3233 3239
34. SchmierJ
LiS
KingJCJr
NicholK
MahadeviaPJ
2008 Benefits and costs of immunizing children against influenza at school: an economic analysis based on a large-cluster controlled clinical trial. Health Affairs 27 w96 w104
35. TeufelIRJ
BascoWTJr
SimpsonKN
2008 Cost effectiveness of an inpatient influenza immunization assessment and delivery program for children with asthma. J Hosp Med 3 134 141
36. SaloH
KilpiT
SintonenH
LinnaM
PeltolaV
2006 Cost-effectiveness of influenza vaccination of healthy children. Vaccine 24 4934 4941
37. AballeaS
ChancellorJ
MartinM
WutzlerP
CarratF
2007 The cost-effectiveness of influenza vaccination for people aged 50 to 64 years: an international model. Value in Health 10 98 116
38. AballeaS
De JuanesJR
BarbieriM
MartinM
ChancellorJ
2007 The cost effectiveness of influenza vaccination for adults aged 50 to 64 years: a model-based analysis for Spain. Vaccine 25 6900 6910
39. MaciosekMV
SolbergLI
CoffieldAB
EdwardsNM
GoodmanMJ
2006 Influenza vaccination. Health impact and cost effectiveness among adults aged 50 to 64 and 65 and older. Am J Prev Med 31 72 79
40. NewallAT
ScuffhamPA
KellyH
HarsleyS
MacIntyreCR
2008 The cost-effectiveness of a universal influenza vaccination program for adults aged 50–64 years in Australia. Vaccine 26 2142 2153
41. TurnerDA
WailooAJ
CooperNJ
SuttonAJ
AbramsKR
2006 The cost-effectiveness of influenza vaccination of healthy adults 50–64 years of age. Vaccine 24 1035 1043
42. ColomboGL
FerroA
VinciM
ZordanM
SerraG
2006 Cost-benefit analysis of influenza vaccination in a public healthcare unit. Ther Clin Risk Manag 2 219 226
43. RothbergMB
RoseDN
2005 Vaccination versus treatment of influenza in working adults: a cost-effectiveness analysis. Am J Med 118 68 77
44. SamadAH
UsulMHBHJ
ZakariaD
IsmailR
Tasset-TisseauA
2006 Workplace vaccination against influenza in Malaysia: does the employer benefit? J Occup Health 48 1 10
45. AvritscherEB
CooksleyCD
GeraciJM
BekeleBN
CantorSB
2007 Cost-effectiveness of influenza vaccination in working-age cancer patients. Cancer 109 2357 2364
46. RobertsS
HollierLM
SheffieldJ
LaiblV
WendelGD
2006 Cost-effectiveness of universal influenza vaccination in a pregnant population. Obstet Gynecol 107 1323 1329
47. BurlsA
JordanR
BartonP
OlowokureB
WakeB
2006 Vaccinating healthcare workers against influenza to protect the vulnerable-Is it a good use of healthcare resources? A systematic review of the evidence and an economic evaluation. Vaccine 24 4212 4221
48. ChanAL
ShieHJ
LeeYJ
LinSJ
ChanALF
2008 The evaluation of free influenza vaccination in health care workers in a medical center in Taiwan. Pharm World Sci 30 39 43
49. RyanJ
ZoellnerY
GradlB
PalacheB
MedemaJ
2006 Establishing the health and economic impact of influenza vaccination within the European Union 25 countries. Vaccine 24 6812 6822
50. CaiL
UchiyamaH
YanagisawaS
KamaeI
2006 Cost-effectiveness analysis of influenza and pneumococcal vaccinations among elderly people in Japan. Kobe J Med Sci 52 97 109
51. GilmanBH
BonitoAJ
EicheldingerC
2007 Impact of influenza immunization on medical expenditures among medicare elderly, 1999–2003. Am J Prev Med 32 107 115
52. HoshiSL
KondoM
HondaY
OkuboI
2007 Cost-effectiveness analysis of influenza vaccination for people aged 65 and over in Japan. Vaccine 25 6511 6521
53. WangST
LeeLT
ChenLS
ChenTHH
2005 Economic evaluation of vaccination against influenza in the elderly: an experience from a population-based influenza vaccination program in Taiwan. Vaccine 23 1973 1980
54. PostmaMJ
BaltussenRM
HeijnenML
de BergLT
JagerJC
2000 Pharmacoeconomics of influenza vaccination in the elderly: reviewing the available evidence. Drugs Aging 17 217 227
55. PostmaMJ
JansemaP
van GenugtenML
HeijnenML
JagerJC
2002 Pharmacoeconomics of influenza vaccination for healthy working adults: reviewing the available evidence. Drugs 62 1013 1024
56. KunjiK
2004 The Ontario experience with universal vaccination. National Influenza Vaccine Summit. Atlanta
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