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Routine influenza vaccination at EDs reduces cost
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SAN FRANCISCO — Offering influenza vaccination regularly to patients presenting to a pediatric emergency department lessens the financial and patient burden of pediatric influenza, according to recent research presented at the 2016 AAP National Conference and Exhibition.
“In our ED, we had not regularly offered flu vaccines to patients through the 2013-2014 season. My research project in residency revolved around surveying families to determine whether families would be interested or willing to receive influenza vaccine during an ED visit for a non-critical illness,” Rebecca Hart, MD, pediatric emergency medicine fellow at the University of Louisville told Infectious Diseases in Children.
“We found that many families who intended to become vaccinated during the influenza season did not go on to become vaccinated, and that at least 50% of those families were interested in being able to obtain influenza vaccine in the pediatric ED. That led us to consider whether regularly offering the vaccine would be feasible,”she added.
“For this project, [my colleagues and] I utilized TreeAge Pro software [TreeAge Software Inc.] to analyze the cost-effectiveness of four different strategies for offering flu vaccine in the pediatric ED,” Hart said. The strategies they assessed consisted of offering the vaccine to four groups: all patients, only patients aged 0 to 5 years, patients at ‘high-risk’ for influenza-related complications according to CDC guidelines or no patients.
Hart and colleagues reviewed literature to identify baseline factors including the likelihood of influenza illness and baseline vaccination, as well as the cost of vaccine, outpatient visits for influenza, hospitalizations and death from influenza. They also used information on parents’ willingness to vaccinate their children in the ED from the previous study, she said. Further, they performed a sensitivity analysis to determine the influence of uncertainties among input variables such as influenza prevalence, vaccine price and effectiveness and costs of complications.
“Using this information, the software determined that the most cost-effective strategy was to offer the vaccine to all patients” at a cost of $93.33 per case of influenza averted, Hart said. “When compared to offering the vaccine to no one, offering to everyone saved an estimated $27 per patient and averted an additional 27 cases of flu [per 1,000 patients].”
Furthermore, offering vaccination to all patients yielded an estimated incremental cost-effectiveness ratio of $1,030.11 per additional case of influenza averted compared with offering vaccination to no patients, according to Hart. “The cost per QALY saved was estimated at $55,258, which is in keeping with accepted standards for pediatric interventions,” she added.
A Monte Carlo analysis revealed that in 99.8% of cases, offering influenza vaccination to all patients was the superior strategy.
Cost-effectiveness of influenza vaccination in the pediatric ED was based on a societal standpoint which suggested that “the strategy of offering vaccine to everyone had a net monetary benefit under a wide variety of conditions in sensitivity analyses,” Hart concluded. — by Alaina Tedesco
Reference:
Hart R, et al. Abstract #319814. Presented at: AAP National Conference and Exhibition; Oct. 22-25, 2016; San Francisco, California.
Disclosure: Hart received a grant from the department of pediatrics at the University of Louisville to fund the cost of the TreeAge software.