Economic analysis of pharmacist-administered influenza immunizations in Ontario

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1 Economic analysis of pharmacist-administered influenza immunizations in Ontario Daria O Reilly, Gord Blackhouse, Sheri Burns, Jim Bowen, Natasha Burke, Jeff Mehltretter, Sherilyn Houle, Nancy Waite April 25, 2017

2 Background In 2012, ON pharmacists were authorized to administer flu vaccines to individuals aged 5 years under the UIIP. Goal was to increase the immunization uptake of the general population Improve accessibility It is important to estimate the economic impact of this new program. 2

3 Objectives To estimate the: 1) Change in # of vaccinations and vaccinationassociated costs; 2) annual flu-related outcomes and healthcare costs; 3) change in productivity costs before/after the implementation of the program (2011/12 vs. 2013/14). 3

4 CHANGES IN VACCINATIONS & COSTS 4

5 Data used to determine # of vaccinations PhC, MD billing data, & PH flu vaccination distribution data, for 2 flu seasons (2011/12 & 2013/14) 5

6 Influenza vaccinations by provider 3,500,000 3,000,000 2,500,000 20% of Population 23% of Population 2,000,000 1,500,000 1,000, , /12 Season 2013/14 Season 2.62 million 3.07 million MD Public Health Other Pharmacists 6

7 Influenza vaccinations by provider 3,500,000 3,000,000 20% of Population + 448,000 23% of Population +3% of Population 2,500,000 2,000,000 1,500,000 1,000, , /12 Season 2013/14 Season 2.62 million 3.07 million MD Public Health Other Pharmacists 7

8 Influenza vaccinations by provider 3,500,000 3,000,000 2,500,000 2,000,000 20% of Population + 448,000 23% of Population +3% of Population + 765,000, Phc - 74,000, Other - 156,000, PH 1,500,000 1,000,000-87,000, MD s 500, /12 Season 2013/14 Season 2.62 million 3.07 million MD Public Health Other Pharmacists 8

9 Cost per vaccination by provider MD Pharmacist Public health Vaccine $5.43 $5.43 $5.43 Provider fee $8.33 $7.50 $5.00 Total $13.76 $12.93 $10.43 Cost to vaccinate an additional 448,000 people was $6.3M 9

10 IMPACT ON FLU-RELATED OUTCOMES & COSTS 10

11 Modelling influenza-related outcomes Variable Ages 5-64 Ages 65+ Source Probability of contracting influenza Prosser Flu related GP visits per 100, Kwong Flu related ED visits per 100, Kwong Flu related hospitalizations per 100, Flu related deaths per 100, Reduction in flu outcomes from vaccination Public Health Ontario Public Health Ontario Prosser 11

12 Outcomes avoided from vaccinations Outcome # avoided based on increase in vaccinations (448,278) Flu cases 20,063 Flu related office visits 466 Flu related ED visits 129 Flu related hospitalizations 107 Flu related deaths

13 Healthcare resource unit costs Healthcare Resource Value Source MD office Visit $36 Sander ED visit $229 Sander Flu hospitalization $6,689 Sander Costs inflated to 2016 Canadian dollars 13

14 Flu outcome-related costs saved from increased vaccinations Costs saved due Health Care Resource to increase in vaccinations (448,278) Flu-related office visits $16,986 Flu-related ED visits $29,595 Flu-related hospitalizations $716,577 Total Health Care Resource Costs $763,158 14

15 PRODUCTIVITY COSTS 15

16 Productivity costs Two situations may lead to productivity losses: 1. Time invested in order to be vaccinated; Vaccinations provided by pharmacists may result in less time off work because of improved access 2. Time lost due to illness from the flu. More individuals vaccinated will lead to fewer cases of the flu and therefore less time taken off work. 16

17 Assumptions Time invested to get vaccinated Variable Value Source % of vaccinations that result in time taken off work Pharmacist 0% Assumption MD 100% Assumption Public health nurse/other 50% Region of waterloo Hours taken off work per vaccination 2 Ray Proportion of Individuals that are employed 5-64 years old 0.63 Stats Can 65 years plus 0.13 Stats Can Average Hourly wage $26.11 Stats Can 17

18 Productivity costs time invested to get vaccinated Provider Change in # of Vaccinations Hours taken off work per Vaccination Cost of time invested (millions) Pharmacy +764, $0 MD -86, * -$1.9 Public Health -155, $1.7 Other -74, $0.8 Total +448,278 -$4.5 Adjusted by the # of people employed based on age 18

19 Assumptions Time lost due to influenza illness Variable Value Source Hours taken off work per flu episode 14 Shiner % of Individuals that are employed 5-64 years old 63% Stats Can 65 years plus 13% Stats Can % of flu episodes resulting in time off work* 100% Assumption Average Hourly wage $26.11 Stats Can *amongst individuals that are employed 19

20 Productivity losses due to illness Change in flu episodes Change in hours taken off work Hourly Wage Change in Productivity Cost (millions) -20, ,007 $ $3.4 20

21 Total change in costs Costs (millions) Vaccination costs (+448,000 vaccinations) +$6.3 Direct flu-outcome related costs -$0.8 Subtotal healthcare costs +$5.5 Productivity Costs for Time Invested -$4.5 Productivity Costs for Time Lost -$3.4 Subtotal Productivity Costs -$7.9 Total Change in Costs -$2.3 Ontario Costs reduced by $2.3 million 21

22 Summary In the post period, there was an increase in vaccine uptake and decrease in flu-related healthcare costs Potentially saved $2.3 million if productivity costs are considered 22

23 For further information, please contact: McMaster University Programs for Assessment of Technology in Health (PATH) Research Institute Daria O Reilly, MSc, PhD Associate Professor Department of Health Research Methods, Evidence and Impact McMaster University Associate Director, Programs for Assessment of Technology in Health (PATH) Research Institute St Joseph s Healthcare Hamilton Telephone: (905) (PATH) Ext Fax: (905) oreilld@mcmaster.ca Website: 43 Charlton Ave E, 2 nd Floor Hamilton, ON, L8N 1Y3 23