Influenza vaccine administered to all pediatric emergency department patients may be cost-effective

1. In this cost-effectiveness analysis, offering influenza vaccination to all eligible patients in the pediatric emergency department (PED) provided the lowest cost per case of influenza averted as compared to no vaccination at all, only vaccinating patients younger than 5 years old, or only vaccinating high-risk patients of all ages.

2. Vaccinating all patients in the PED saves $33.51 per case of influenza averted compared with no vaccination, and averages 27 fewer cases of influenza per 1000 patients.

Evidence Rating Level: 2 (Good)

Study Rundown: Influenza is a significant public health issue in the pediatric population given its morbidity, mortality and costs. Strategies to increase vaccination rates, including vaccination in the pediatric emergency department (PED), may help decrease this burden. This cost-effectiveness analysis aimed to compare 4 strategies for PED-based influenza vaccines: offering vaccines to all patients, only to patients less than 5 years old, only to high risk patients of all ages and to no patients.

Offering influenza vaccination to all eligible patients in the PED provided the lowest cost per case of influenza averted at $114.45, which was $33.51 lower per case averted as compared to no vaccination. With this strategy, there were approximately 27 fewer cases of influenza per 1000 patients. Strengths of this study include assessment of different age and risk levels as inclusion criteria for vaccination. However it was assumed that children receiving a single vaccination were “vaccinated” and it is known that children less than 9 years old should receive 2 doses of vaccine in the first year of vaccination, and thus levels of immunity may be overestimated.

Click to read the study, published in JAMA Pediatrics

Relevant Reading: Deaths averted by influenza vaccination in the U.S. during the seasons 2005/06 through 2013/14

In-Depth [cost-effectiveness analysis]: Commercial decision analysis software was used to compare 4 different influenza vaccine strategies among a hypothetical cohort of children visiting a tertiary, urban PED from January 2016 to June 2017 during influenza season. The 4 strategies for PED-based influenza vaccination are: offering vaccines to all patients, only to patients younger than 5 years old, only to high risk patients of all ages or to no patients at all. Outcomes of interest were cost and incremental cost-effectiveness ratio in dollars per influenza case averted. Secondary outcomes included total societal costs, hospitalizations and deaths averted and quality-adjusted life-years gained. Sensitivity analyses estimated the effect of many uncertainties across a variety of input variables (influenza prevalence, vaccine price and effectiveness and costs of complications).

Offering the influenza vaccine to all eligible patients resulted in the lowest cost per case of influenza averted: $114.45 (95% CI $55.48-$245.45) as compared to no vaccination. This resulted, on average, in 27 fewer cases of influenza per 1000 patients. The strategy saves $33.51 (95% CI $18-$62). Vaccination of all eligible patients resulted in 0.72 days (95% CI 0.18-1.78 days) of quality-adjusted life-years lost as compared to 0.91 days (95% CI 0.25-2.2 days) in the no vaccination group.

Image: PD

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