Is a Mass Immunization Program for Pandemic (H1N1) 2009 Good Value for Money? Early Evidence from the Canadian Experience

Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
Vaccine (Impact Factor: 3.62). 08/2010; 28(38):6210-20. DOI: 10.1016/j.vaccine.2010.07.010
Source: PubMed


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). 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.

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    • "Vaccination can protect healthy people from infection and reduce the spread of the virus in the population. In the cost benefit analysis of a mass influenza A vaccination program in Ontario, Canada, Beate Sander and Chris T. Bauch(9) drew the conclusion that vaccination is not only effective and cost-beneficial, and also more effective if it was carried out earlier. As to the reason why it cost so much in influenza A H1N1 vaccination, the study thought that influenza A H1N1 is a new pandemic virus, therefore the cost of research and produce was more expensive. "
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    ABSTRACT: In order to provide guidance on the efficient allocation of health resources when handling public health emergencies in the future, the study evaluated the H1N1 influenza prevention and control program in Hubei Province of China using cost-benefit analysis. The costs measured the resources consumed and other expenses incurred in the prevention and control of H1N1. The assumed benefits include resource consumption and economic losses which could be avoided by the measures for the prevention and control of H1N1. The benefit was evaluated by counterfactual thinking, which estimates the resource consumption and economic losses could be happened without any measures for the prevention and control, which have been avoided after measures were taken to prevent and control H1N1 in Hubei Province, these constitutes the benefit of this project. The total costs of this program were 38.81 million U.S. dollars, while the total benefit was assessed as 203.71 million U.S. dollars. The net benefit was 164.9 million U.S. dollars with a cost-effectiveness ratio of 1:5.25. The joint prevention and control strategy introduced by Hubei for H1N1 influenza is cost-effective.
    Iranian Journal of Public Health 11/2012; 41(11):34-43. · 0.55 Impact Factor
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    • "In a recent article, Sander et al. [15] used an agent-based model to depict the spread of H1N1 in Ontario. They asserted that the immunization program in the province was a " cost-effective " means to prevent H1N1 cases. "
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    ABSTRACT: We analyzed the effects of the timing of vaccine distribution in 11 U.S. states during the 2009 H1N1 influenza pandemic. By using reported data on the fraction of patients presenting with flu-related symptoms, we developed a transformation that allowed estimation of the state-specific temporal flu wave curve, representing the number of new infections during each week. We also utilized data describing the weekly numbers of vaccine doses delivered and administered. By using a simple difference equations model of flu progression, we developed two influenza wave curves: first, an "observable" curve that included the beneficial effects of vaccinations, and second, an unobservable curve that depicted how the flu would have progressed with no vaccine administered. We fit the observable curve to match the estimated epidemic curve and early exponential growth associated with R0, the reproductive number. By comparing the number of infections in each scenario, we estimated the infections averted by the administration of vaccine. Southern states experienced peak infection several weeks before northern states, and most of the vaccine was delivered well after the peak of the southern flu wave. Our models suggest that the vaccine had minimal ameliorative impact in the southern states and measurable positive impact in the northern states. Vaccine delivery after peak also results in a smaller fraction of the population's seeking the vaccine. Our analysis suggests that current Centers for Disease Control and Prevention policy of allocating flu vaccine over time in direct proportion to states' populations may not be best in terms of averting nationally the maximum possible number of infections.
    Value in Health 02/2012; 15(1):158-66. DOI:10.1016/j.jval.2011.07.014 · 3.28 Impact Factor
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    ABSTRACT: Background: The first pandemic of the millennium was declared in June 2009. At that time, the pH1N1 virus was already in circulation in Canada and early reports from around the world indicated a potentially severe pandemic. The initial projections did not materialize but it was not clear whether this was due to the nature of the virus, or the success of public health initiatives. The objective of this analysis was to examine the effectiveness of the interventions used in Canada from both a health and economic point of view. Methods and Findings: A mathematical model was fitted to the observed Canadian hospitalizations and deaths including the reported antiviral and vaccine interventions. In addition to the number of infections, hospitalizations, deaths and quality adjusted life years (QALYs) lost, the model also determined the indirect economic impact on GDP driven by absenteeism. The model yielded an attack rate of 15%. By turning off the interventions, the potential impact of the unmitigated pH1N1 pandemic was evaluated and found to have an attack rate of 28%. The interventions reduced hospitalizations by 55%, deaths by 74%, QALYs lost (3% discounted) by 69% and the GDP impact by 49%. In 2009 dollars, the net cost of the combined antiviral and vaccine intervention was $11,145 per QALY gained indicating that the interventions were very cost-effective. This includes costs saved from the reduced hospitalizations and doctor visits. Conclusions: Without the reported use of antivirals and vaccine during 2009 in Canada, the analysis indicated that the pandemic impact of pH1N1 could have had an attack rate of 28%, twice the hospitalizations and GDP impacts, almost three times the hospitalization costs and QALYs lost; and almost four times the number of deaths. Such pandemic intervention policies were also very cost-effective with an incremental cost-effectiveness ratio of $11,145 per QALY gained.
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