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Influenza vaccination in pediatric EDs cost-effective
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Administering immunization against influenza in pediatric ED settings to all eligible patients demonstrates cost-efficacy and can reduce the number of infections by 27 cases per 1,000, according to a study published in JAMA Pediatrics.
“The ED may help increase coverage [of the influenza vaccine] specifically because it serves as a location where patients are already presenting for care, often for relatively low-acuity complaints and illnesses like ear infections and sports injuries,” Rebecca J. Hart, MD, from the division of pediatric emergency medicine at the University of Louisville, said in an interview with Infectious Diseases in Children. “If lack of time is a significant barrier to parents obtaining the vaccine for their children, then eliminating the need to make a separate doctor or clinic visit to obtain the vaccine may be particularly helpful.”
To examine four strategies and cost-effectiveness for administering influenza immunizations in the pediatric ED setting, including offering the vaccine to all patients, only to patients younger than 5 years, only to high-risk patients of all ages or to no patients, the researchers conducted a cost-effectiveness analysis. The examination was completed using commercial decision analysis software. All cost-effectiveness data was studied from Jan. 1, 2016, to June 1, 2017.
The pediatric ED in which the study was completed was a tertiary, urban, freestanding ED that serves nearly 60,000 visitors annually. The analysis was completed using a hypothetical cohort of children using the ED in the midst of the influenza season. Effects of vaccination and uncertainty regarding disease prevalence, vaccine price and effectiveness and costs of complications were estimated using sensitivity analyses.
Hart and colleagues ultimately calculated the cost and increasing cost-effectiveness of administering influenza vaccines ratio using dollars per infection circumvented. The researchers also examined total societal costs, hospitalizations and deaths evaded and quality-adjusted life-years added.
The lowest cost was observed in the scenario in which all eligible patients received the vaccine, with $114.45 saved per case avoided (95% CI, $55.48-$245.45). Compared with no vaccinations administered, this strategy saves $33.51 per case (95% CI, $18-$62) and can reduce the number of influenza cases by 27 per 1,000 patients.
Concerning quality-adjusted life-years lost, offering the vaccine to all pediatric ED visitors resulted in 0.72 days lost (95% CI, 0.18-1.78 days). This number was higher when no vaccines were offered (0.91; 95% CI, 0.25-2.2 days). Additionally, this strategy is significantly cost-effective in sensitivity analyses.
Although this strategy is cost-effective, the researchers note that other benefits of administering vaccines within the pediatric ED are observable. Vaccinating against influenza in the ED leads to a net social monetary benefit in many instances, and providing the vaccine to all patients demonstrated superiority over 99.8% of other strategies in a Monte Carlo analysis.
“Vaccinating children in the ED may be simpler than anticipated,” Hart said. “While initial start-up costs may be an issue for some centers, we used stock of vaccine that was already supplied for the hospital and kept costs relatively low. Based on the findings of the study, the vaccine program is cost-effective even if an individual center has higher administrative costs than we did.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.
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