Cost-Effectiveness of Influenza Vaccine

Influenza vaccination can reduce both health-care costs and productivity losses associated with influenza illness. Studies of influenza vaccination of persons aged >65 years conducted in the United States have reported substantial reductions in hospitalizations and deaths and overall societal cost savings (159,160,266). Studies of adults aged <65 years have reported that vaccination can reduce both direct medical costs and indirect costs from work absenteeism (129,130,132-134,267). Influenza vaccination has been estimated to decrease costs associated with influenza illness, including 13%-44% reductions in health-care-provider visits, 18%-45% reductions in lost workdays, 18%-28% reductions in days working with reduced effectiveness, and 25% reductions in antibiotic use for influenza-associated illnesses (129,131,268,269). One analysis estimated a cost of approximately $4,500 per illness averted among healthy persons aged 18-64 years in a typical season, with cost/case averted decreasing to as low as $60 when the influenza attack rate and vaccine effectiveness against ILI are high (130). Another cost-benefit analysis that also included costs from lost work productivity estimated an average annual savings of $13.66 per person vaccinated (270).

Economic studies specifically evaluating the cost-effectiveness of vaccinating persons in other age groups currently recommended for vaccination (e.g., persons aged 50-64 years or children aged 6-59 months) are limited and typically demonstrate much higher costs in these healthier populations (266,271-274). In a study of inactivated vaccine that included persons in all age groups, cost utility (i.e., cost per year of healthy life gained) improved with increasing age and among those with chronic medical conditions (266). Among persons aged >65 years, vaccination resulted in a net savings per quality-adjusted life year (QALY) saved. Another study estimated the cost-effectiveness of influenza vaccination to be $28,000 per QALY saved (in 2000 dollars) in persons aged 50-64 years compared with $980 per QALY saved among persons aged >65 years (275).

Cost analyses have documented the considerable cost burden of illness among children. In a study of 727 children at a single medical center during 2000-2004, the mean total cost of hospitalization for influenza-related illness was $13,159 ($39,792 for patients admitted to an intensive care unit and $7,030 for patients cared for exclusively on the wards) (276). Strategies that focus on vaccinating children with medical conditions that confer a higher risk for influenza complications appear to be more cost-effective than a strategy of vaccinating all children (277). An analysis that compared the costs of vaccinating children of varying ages with TIV and LAIV determined that costs per QALY saved increased with age for both vaccines. In 2003 dollars per QALY saved, costs for routine vaccination using TIV were $12,000 for healthy children aged 6-23 months and $119,000 for healthy adolescents aged 12-17 years, compared with $9,000 and $109,000 using LAIV, respectively (278).

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