Analysis finds Ontario's universal flu vaccination policy cost-effective

Apr 6, 2010 (CIDRAP News) – An analysis of Ontario's universal flu vaccination program, which targets free flu vaccine for anyone over 6 months old, is cost-effective and may be an attractive option for other provinces and countries that have single-payer health systems, researchers reported today.

Ontario instituted its universal flu vaccination policy in 2000, and researchers have already shown in a 2008 study that free flu vaccine for everyone, compared with more targeted strategies used by other Canadian provinces, can increase immunization rates, decrease flu deaths, and reduce flu-related use of healthcare facilities. However, the latest analysis, which appears today in Public Library of Science (PLoS) Medicine, is the first to explore economic issues related to the policy.

Expanding the scope of flu vaccination is one tool health officials have used to drive down both the health and the economic costs of seasonal flu. The United States took a big step forward on Feb 24 when the Center for Disease Control and Prevention's (CDC's) Advisory Committee on Immunization Practices (ACIP) passed a long-awaited universal flu immunization recommendation for all except babies younger than 6 months. Experts hope the new recommendation will streamline and clarify the government's yearly messages about flu immunization.

Most Canadian provinces target free seasonal flu vaccines to people age 65 and older, those with chronic health conditions, and healthcare workers.

Though the new research findings shed new light broadly on the economic feasibility for universal flu vaccination, they are likely to be most useful to countries that have single-payer health systems in which government bears both the burden of flu illnesses and the cost of flu immunization programs.

Researchers compared vaccine uptake, doctor visits, emergency department visits, hospitalizations, and deaths from seasonal flu in Ontario and nine other Canadian provinces between 1997 and 2004, a time frame that includes seven flu seasons, including the years before and after Ontario adopted its universal flu vaccination policy. They used Ontario sources for program costs the medical literature for quality-adjusted life year (QALY) measures.

They found that Ontario's universal flu vaccine program cost about twice as much as the targeted programs offered by other provinces: $40 million versus $20 million. However, the group calculated that Ontario's program reduced influenza cases by 61% and cut mortality by 28%. Preventing the cases trimmed flu-related healthcare costs by 52%, saving Ontario's health system about $7.8 million for each flu season.

When calculating the expenditure needed to generate a year of perfect health, expressed as cost per QALY, they determined that Ontario's universal vaccination program was about $11,000 per QALY gained, a level considered cost-effective in more affluent countries such as Canada.

Ontario's net cost for the universal flu immunization program was $12.2 million, or about $2.60 per person vaccinated.

The study concluded that Ontario's program is economically attractive, with costs that are partly (39%) offset by healthcare cost savings and that similar programs may be attractive to high-income jurisdictions that are demographically similar to Ontario.

Amanda Honeycutt, PhD, a senior economist at RTI International, a research institute based in Triangle Park, N.C., told CIDRAP News that the study was nicely done, though the cost-effectiveness and QALY-level findings weren't too surprising. "The results are in line with what you'd expect," she said, adding that the healthcare costs didn't completely offset the cost of immunization.

The program's net costs were fairly low, but she said, adding that even promoting healthcare interventions that have a low net cost is often an uphill battle,

"Prevention is often thought of as a magic bullet for healthcare savings, but there's an extremely high bar," Honeycutt said. "But if you were to line this [universal flu immunization policy] up with other interventions, this would look very good."

She pointed out that the study is done from a payer perspective and that it doesn't factor in costs such as time off work.

Honeycutt said she's not sure how generalizable the study's immunization cost calculations are to other settings. The authors reported that Ontario's cost of administering each flu vaccine dose is about $7.55, which is much lower than the median cost for administering a vaccine dose in the United States, which ranges around $20. However, she credited the authors for doing a sensitivity analysis for that finding, which revealed that expenditure was still reasonable, even if Ontario's per-dose cost was doubled.

The study shows that universal flu vaccination is a worthwhile investment for Ontario, and it may also sway other health systems to consider similar policies, Honeycutt said.

Sander B, Kwong JC, Bauch CT, et al. Economic appraisal of Ontario's universal influenza immunization program: a cost-utility analysis. PLoS Medicine 2010 Apr 6;7(4):[Full text]

See also:

Oct 29, 2008, CIDRAP News story "Study: universal flu immunization lowers death rates"

Apr 6 PLoS Medicine press release

Feb 24 CIDRAP News story "ACIP recommends annual flu shots for almost all"

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