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Cost-effectiveness of Strategies for Offering Influenza Vaccine in the Pediatric Emergency Department.
JAMA Pediatr. 2018 01 02; 172(1):e173879.JP

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 Participants

Using 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 Measures

The 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.

Results

Offering influenza vaccine to all eligible patients has the lowest cost, at $114.45 (95% CI, $55.48-$245.45) per case of influenza averted. This strategy saves $33.51 (95% CI, $18-$62) per case averted compared with no vaccination, and averages 27 fewer cases of influenza per 1000 patients. Offering vaccine to all patients resulted in 0.72 days (95% CI, 0.18-1.78 days) of quality-adjusted life-years lost, whereas offering to none resulted in 0.91 days (95% CI, 0.25-2.2 days) of quality-adjusted life-years lost. In sensitivity analyses, this strategy remains robustly cost-effective across a wide range of assumptions. In addition to being the most cost-effective strategy regardless of age or risk status, routine vaccination in the PED results in a net societal monetary benefit under many circumstances. In Monte Carlo analysis, offering vaccine to all patients was superior to other strategies in at least 99.8% of cases.

Conclusions and Relevance

Although few PEDs routinely offer influenza vaccination, doing so appears to be cost-effective, with the potential to significantly reduce the economic (and patient) burden of pediatric influenza.

Authors+Show Affiliations

Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville, Louisville, Kentucky.Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville, Louisville, Kentucky.Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Louisville, Louisville, Kentucky.Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky.Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville, Louisville, Kentucky.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29114729

Citation

Hart, Rebecca J., et al. "Cost-effectiveness of Strategies for Offering Influenza Vaccine in the Pediatric Emergency Department." JAMA Pediatrics, vol. 172, no. 1, 2018, pp. e173879.
Hart RJ, Stevenson MD, Smith MJ, et al. Cost-effectiveness of Strategies for Offering Influenza Vaccine in the Pediatric Emergency Department. JAMA Pediatr. 2018;172(1):e173879.
Hart, R. J., Stevenson, M. D., Smith, M. J., LaJoie, A. S., & Cross, K. (2018). Cost-effectiveness of Strategies for Offering Influenza Vaccine in the Pediatric Emergency Department. JAMA Pediatrics, 172(1), e173879. https://doi.org/10.1001/jamapediatrics.2017.3879
Hart RJ, et al. Cost-effectiveness of Strategies for Offering Influenza Vaccine in the Pediatric Emergency Department. JAMA Pediatr. 2018 01 2;172(1):e173879. PubMed PMID: 29114729.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of Strategies for Offering Influenza Vaccine in the Pediatric Emergency Department. AU - Hart,Rebecca J, AU - Stevenson,Michelle D, AU - Smith,Michael J, AU - LaJoie,A Scott, AU - Cross,Keith, Y1 - 2018/01/02/ PY - 2017/11/9/pubmed PY - 2019/9/7/medline PY - 2017/11/9/entrez SP - e173879 EP - e173879 JF - JAMA pediatrics JO - JAMA Pediatr VL - 172 IS - 1 N2 - 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 Participants: Using 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 Measures: The 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. Results: Offering influenza vaccine to all eligible patients has the lowest cost, at $114.45 (95% CI, $55.48-$245.45) per case of influenza averted. This strategy saves $33.51 (95% CI, $18-$62) per case averted compared with no vaccination, and averages 27 fewer cases of influenza per 1000 patients. Offering vaccine to all patients resulted in 0.72 days (95% CI, 0.18-1.78 days) of quality-adjusted life-years lost, whereas offering to none resulted in 0.91 days (95% CI, 0.25-2.2 days) of quality-adjusted life-years lost. In sensitivity analyses, this strategy remains robustly cost-effective across a wide range of assumptions. In addition to being the most cost-effective strategy regardless of age or risk status, routine vaccination in the PED results in a net societal monetary benefit under many circumstances. In Monte Carlo analysis, offering vaccine to all patients was superior to other strategies in at least 99.8% of cases. Conclusions and Relevance: Although few PEDs routinely offer influenza vaccination, doing so appears to be cost-effective, with the potential to significantly reduce the economic (and patient) burden of pediatric influenza. SN - 2168-6211 UR - https://www.unboundmedicine.com/medline/citation/29114729/Cost_effectiveness_of_Strategies_for_Offering_Influenza_Vaccine_in_the_Pediatric_Emergency_Department_ L2 - https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2017.3879 DB - PRIME DP - Unbound Medicine ER -