Cost-effectiveness of influenza immunisation programmes

Transcription

1 High-level hearing on the implementation of the Council Recommendation on seasonal influenza vaccination, Luxembourg, April 2015 Cost-effectiveness of influenza immunisation programmes Mark Jit Modelling and Economics Unit, Public Health England Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine I have no conflicts of interest to declare 11 May 2015

2 Why does health economics matter? Opportunity cost The cost of a choice is measured in terms of the value of best alternative foregone.

3 Why does health economics matter? Opportunity cost The cost of a choice is measured in terms of the value of best alternative foregone. Influenza vaccine HPV vaccine Influenza vaccine New school Immunisation budget Public sector budget Choices like this are being made all the time. Health economics helps to make the trade-offs explicit.

4 What is cost-effectiveness analysis? ECO- NOMIC HEALTH VACCINE COSTS ECO- NOMIC HEALTH NO VACCINE VACCINE

5 Why does health economics matter? Incremental costeffectiveness ratio = Incremental costs Incremental health gains = VACCINE COSTS ECONOMIC - ECONOMIC Measured in quantities like: episodes of disease prevented life years gained QALYs or DALYs gained HEALTH VACCINE - HEALTH NO VACCINE

6 The influenza burden iceberg Hospital admissions Mortality Primary care attendances Cases treated at home Infection transmission Absenteeism in patients and caregivers Human suffering Disruption in daily activities Non-specific excess winter deaths Out-of-pocket expenses Cost of outbreak investigations Reduced demand in the economy Presenteeism Investment flows Fear and anxiety

7 Economic burden of influenza Szucs et al. J Antimicrobial Chemother 1999; 44:B11. Estimated economic burden of influenza in 281 German patients (1995-6) Inpatient DM3.4 m Outpatient DM13.1 m Medication DM9.3 m

8 Economic burden of influenza Szucs et al. J Antimicrobial Chemother 1999; 44:B11. Estimated economic burden of influenza in 281 German patients (1995-6) Inpatient DM3.4 m Outpatient DM13.1 m Relevant to health care providers, insurers, Ministries of Health Medication DM9.3 m Productivity DM119.7 m Relevant to employers, families, Ministries of Finance

9 Absenteeism McMenamin TM. Issues in Labor Statistics 2010; 10-06:1-4.

10 Principi et al. Pediatr Infect Dis J 2003; 22:S Caregivers and sibilings Italian questionnaire based study

11 Ways of measuring productivity losses Friction costs Cost of replacing the lost production of a worker (eg. filling the vacancy with a new hire) Present value of lost earnings (PVLE) Value of the lost production (or earnings) of a worker over the remaining lifetime Value of statistical life (VSL) Value of the lost production (or earnings) of a worker over the remaining lifetime + Social value of human life (eg. from wage-risk tradeoffs)

12 Total Cost (US$bn, 2003) Ways of measuring productivity losses Estimated economic burden of influenza in the United States (2003) $80 $70 $60 $50 $40 $30 $20 $10 Medical Medical + PVLE Medical + VSL $0 No medical care Outpatient only Hospitalised Death Adapted from Molinari et al. Vaccine 2007; 25:5086.

13 Macroeconomic effects SARS in Beijing Beutels et al. Trop Med Int Health 2009; 14 Suppl 1:85.

14 Macroeconomic effects The effect of vaccination on UK GDP during a 1918/1958/1969-like pandemic Smith et al. BMJ 2009; 339:b4571.

15 Cost-effectiveness studies of flu vaccination Review Target group Studies Conclusion Newall 2012 Children Cost saving or cost-effective Coleman 2006 Children 7 Not discussed Nichol 2011 Children Cost saving or cost-effective Savidan 2008 Children <18 15 Cost saving or cost-effective Burls 2006 Conclusions from a review of reviews Healthy adults, healthcare workers 14 Mostly cost saving Gatwood 2012 Healthy adults y 7 Generally not cost saving Hogan 2012 Healthy adults 10 Mostly favoured vaccination Newall 2009 Adults y 6 Cost-effective De Waure 2012 Adults >50 y, high-risk 20 Cost saving or cost-effective Postman 2006 Elderly 18 Most cost saving or costeffective Jit et al. Human Vaccines & Immunotherapeutics 2013; 9:5..