Cost-effectiveness of Strategies for Offering Influenza Vaccine in the Pediatric Emergency Department

Abstract

IMPORTANCE Influenza is a significant public health burden, causing morbidity and mortality in children, yet vaccination rates remain low. Vaccination in the pediatric emergency department (PED) setting may be beneficial but, to date, has not been proven to be cost-effective.OBJECTIVE To compare the cost-effectiveness of 4 strategies for PED-based influenza vaccine: offering vaccine to all patients, only to patients younger than 5 years, only to high-risk patients (all ages), or to no patients. DESIGN, SETTING, AND PARTICIPANTSUsing commercial decision analysis software, a cost-effectiveness analysis was performed from January 1, 2016, to June 1, 2017, to compare influenza vaccine strategies at a tertiary, urban, freestanding PED with an estimated 60 000 visits per year among a hypothetical cohort of children visiting the above PED during influenza season. Sensitivity analyses estimated the effect of uncertainties across a variety of input variables (eg, influenza prevalence, vaccine price and effectiveness, and costs of complications). MAIN OUTCOMES AND MEASURESThe primary outcomes 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.

Vaccinating in the Emergency Department, a Novel Approach to Improve Influenza Vaccination Rates via a Quality Improvement Initiative

“…Despite these obstacles, the program successfully increased vaccination rates without placing a financial burden on the hospital. Hart et al 29 estimated that the net societal cost of offering the vaccine was $103.69 per patient. Our study is unique as our formal cost analysis demonstrated a $22,500 net profit due in part to the zero cost vaccines from the VFC program.…”

“…This analysis was limited as it did not estimate cost savings from influenza cases averted ($33.51 per case prevented), the cost of possibly wasted vaccines, or the cost of personnel to run the project. 29 This hospital sanctioned influenza vaccination project included an estimated provider and nursing leadership team commitment of 275 staff-hours for planning, collecting, analyzing, and disseminating data, and providing education. This self-sustaining program can be initiated annually by turning on the EHR workflow and re-educating nurses and providers.…”

Childhood and Adolescent Vaccination in Alternative Settings

“…37 Measles and influenza vaccination programs have also been implemented in the ED. 36,38 A recent study found that offering influenza vaccine to all eligible pediatric patients in the ED was cost-effective and did not significantly impact patient flow or staffing needs. 38 Interventions examining routine vaccination in acute care settings have shown mixed results but may have some short-term benefit.…”

Title of Manuscript: Risk-Stratification in Febrile Infants 29 to 60 Days Old: A Cost-Effectiveness Analysis

“…Health state utilities were assigned a value of 0-1, with 0 equivalent to death and 1 representing perfect health (35). Utility values associated with various outcomes were drawn from the literature (31)(32)(33). 36) When quality-of-life studies were not available for this age group, we used quality-of-life estimates from older populations.…”