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Cost-Benefit Analysis of a Strategy to Vaccinate Healthy Working Adults Against Influenza
Kristin L. Nichol, MD, MPH, MBA
Arch Intern Med. 2001;161:749-759.
Background Influenza is a major cause of illness, disruption to daily life, and
work absenteeism among healthy working adults aged between 18 and 64 years.
This group is not included among the traditional priority groups for annual
vaccination. Immunization rates remain low.
Objective To assess the economic implications of a strategy for annual vaccination
of this group.
Methods Using the societal perspective, this cost-benefit analysis included
the direct and indirect costs associated with vaccination as well as the direct
and indirect costs prevented by vaccination. Clinical and economic variable
estimates were derived primarily from the published literature. For this model,
it was assumed that vaccination occurred in efficient, low-cost settings such
as at the work site. Monte Carlo simulation was used to calculate the mean
net costs or savings along with the 95% probability interval, and sensitivity
analyses explored the sensitivity of the cost model to different values of
the input variables.
Results Vaccinating healthy working adults was on average cost saving, with
mean savings of $13.66 per person vaccinated (95% probability interval: net
savings of $32.97 to net costs of $2.18), with vaccination generating net
savings 95% of the time. The model was most sensitive to the influenza illness
rate, the work absenteeism rate due to influenza, and hourly wages. In the
worst-case scenario vaccination was not cost saving. Vaccination also generated
net costs to society during years with a poor vaccine–circulating virus
strain match. In all of the other sensitivity analysis scenarios, vaccination
was cost saving.
Conclusion Influenza vaccination of healthy working adults on average is cost saving.
These findings support a strategy of routine, annual vaccination for this
group, especially when vaccination occurs in efficient and low-cost sites.
From the Center for Chronic Disease Outcomes Research and Medicine
Service, Veterans Affairs Medical Center and University of Minnesota Medical
School, Minneapolis. Dr Nichol has received research funds from infuenza vaccine
manufacturers.
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