Monday, October 25, 2010: 5:00 PM
Grand Ballroom East (Sheraton Centre Toronto Hotel)
Beate Sander, RN, MBA, MEcDev1, Chris T. Bauch, PhD2, David N. Fisman, MD, MPH1, Robert A. Fowler, MD, MSc3, Jeff Kwong, MD, MSc4, Andreas Maetzel, MD, MSc, PhD5, Allison McGeer, MD6, Janet Raboud, PhD6, Damon C. Scales, MD, PhD7, Marija Zivkovic Gojovic, MSc1 and Murray D. Krahn, MD, MSc1, (1)University of Toronto, Toronto, ON, Canada, (2)University of Guelph, Guelph, ON, Canada, (3)Sunnybrook Health Sciences Center, Toronto, ON, Canada, (4)Institute for Clinical Evaluative Sciences, Toronto, ON, Canada, (5)Strategic Access Solutions Ltd, Basel, Switzerland, (6)Mount Sinai Hospital, Toronto, ON, Canada, (7)Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Purpose: In response to the pandemic H1N1 influenza 2009 outbreak, many jurisdictions undertook mass immunization programs that were among the largest in recent history. The objective of this study was to determine the cost-effectiveness of the mass H1N1 immunization program in Ontario, Canada’s most populous province (population 13,000,000).
Methods: A cost-utility analysis comparing the H1N1 mass immunization program in Ontario to no immunization was performed from the health care payer perspective (Ontario Ministry of Health and Long-Term Care). The economic evaluation used projections from a simulation model of a pandemic H1N1 2009 outbreak in a typical Ontario urban center. Health outcomes included number of cases, number of deaths and quality adjusted life-years (QALYs). Estimates of health care resource use (office visits, emergency department (ED) visits, hospitalizations) and deaths were based on Ontario pandemic H1N1 surveillance data. Vaccination program cost and health care cost for treating H1N1 cases and were drawn from Ontario administrative data sources. Primary outcomes were QALYs, costs in 2009 Canadian dollars, and cost per QALY gained (incremental cost-effectiveness ratio (ICER)). Results:
We estimated that 4.1 million cases of symptomatic H1N1 influenza would have occurred (31.5% symptomatic attack rate) in the absence of an immunization program. Our model predicted that 22% of symptomatic cases, 22% of office and ED visits, 23% of hospitalizations, and 25% of deaths were prevented by the program. While the program was costly ($180.4 million), it was also highly cost-effective at $9,388/QALY gained. Projections were highly sensitive to the timing of the immunization program and moderately sensitive to immunization program cost and QALYs. The ICER remained well below World Health Organization thresholds for cost-effectiveness in all deterministic sensitivity analyses. Probabilistic uncertainty analysis confirmed the robustness of results with a likelihood of the program to be cost-effective of 100% at a willingness-to-pay of $30,000/QALY.
Conclusions: This analysis suggests that a mass immunization program as carried out in Ontario and many other high-income health care systems in response to H1N1 2009 was effective in preventing influenza cases and health care resource use and was also highly cost-effective despite the substantial program cost.
Candidate for the Lee B. Lusted Student Prize Competition
