Tuesday, October 21, 2008: 12:00 PM
Grand Ballroom B/C (Hyatt Regency Penns Landing)
Beate Sander, RN, MBA, MEcDev1, Jeff Kwong, MD, MSc2, Chris T. Bauch, PhD3, Andreas Maetzel, MD, MSc, PhD4, Allison McGeer, MD5, Janet Raboud, PhD5 and Murray Krahn, MD, MSc1, (1)University of Toronto, Toronto, ON, Canada, (2)Institute for Clinical Evaluative Sciences, Toronto, ON, Canada, (3)University of Guelph, Guelph, ON, Canada, (4)University Health Network, Toronto, ON, Canada, (5)Mount Sinai Hospital, Toronto, ON, Canada
Purpose: In July 2000, Ontario initiated a universal influenza immunization program (UIIP) to provide free influenza vaccines for the entire population (> 6 months) as opposed to targeted influenza immunization programs (TIIP) that are used in other Canadian provinces. Although this program has generated a mixed response, it is the first large-scale program of its kind worldwide. The benefit and cost-effectiveness of universal vaccination has not yet been evaluated.
Methods: The economic evaluation is a companion study to an ecological study evaluating the impact of Ontario’s UIIP on visits to doctors’ offices, ED visits, hospitalizations and mortality. Based on administrative data from 1996/97 through 2005, this study estimates the mean numbers of events per season post-UIIP implementation as observed in Ontario and compares them with expected numbers of events had Ontario instead continued to offer TIIP, based on TIIP rates in 9 other Canadian provinces. To calculate the expected number of events post-UIIP for Ontario we apply the relative change estimates pre 2000 to post 2000 as observed in other provinces to pre-UIIP Ontario event rates.
Unit costs are based on Ontario administrative data on health care resource utilization, including physician claims and acute care. Immunization program costs were obtained from the Ministry of Health and include all costs related to the program. Utility weights are obtained from the literature. We calculate the incremental cost-effectiveness of the program from the health care payer perspective. The incremental cost-effectiveness ratio is expressed as cost per QALY gained. QALYs due to mortality are discounted at 3%. We perform a series of univariate deterministic sensitivity analyses as well as a probabilistic sensitivity analysis.
Results: The UIIP reduces health care resource utilization. The program costs approximately C$20 million more than a targeted program, but reduces health care services cost by C$8 million. Most cost savings can be attributed to hospitalizations avoided. The program saves 955 QALYs by reducing mortality and additional 552 QALYs by reducing morbidity. The ICER is C$7,971/QALY gained. Results are sensitive to deaths averted, hospitalization cost and utility weights. However, the probability of UIIP being cost-effective at a willingness to pay threshold of C$50,000/QALY is greater than 0.95. Conclusion: UIIP appears to be an economically attractive intervention.
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