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Volume 12, Number 10—October 2006

Research

Health Benefits, Risks, and Cost-Effectiveness of Influenza Vaccination of Children

Lisa A. Prosser*†Comments to Author , Carolyn Buxton Bridges‡, Timothy M. Uyeki‡, Virginia L. Hinrichsen*†, Martin I. Meltzer‡, Noelle-Angelique M. Molinari‡, Benjamin Schwartz‡, William W. Thompson‡, Keiji Fukuda‡, and Tracy A. Lieu*†§
Author affiliations: *Harvard Medical School, Boston, Massachusetts, USA; †Harvard Pilgrim Health Care, Boston, Massachusetts, USA; ‡Centers for Disease Control and Prevention, Atlanta, Georgia, USA; §Children's Hospital, Boston, Massachusetts, USA

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Table 2

US $ cost inputs for children ages 6 months to 17 years*

Cost input Most likely estimate Range for sensitivity analysis
Influenza-related costs
OTC medications† $3
Physician visit, uncomplicated influenza‡ $27 $10–$78
Physician visit, otitis media§ $78 $23–$197
Physician visit, non-hospitalized pneumonia§ $179 $62–$715
Hospitalization¶ $4,300 $1,300–$34,500
Long-term sequelae following influenza-related hospitalization# $625,000 $0–$1,000,000
Vaccination costs
Per dose, IIV** (children <3 y) $9.56†† 1×–4× base case
Per dose, IIV** (children >3 y) $6.86††
Per dose, LAIV** $12.89†† $10–$25
Administration costs (0–2 visits)¶¶ $25 $10–$40
Parent time costs, per visit## $32 $0–$64
Total vaccination costs*** $30–$110
6-23 mo $79
2 y $66
3–4 y $59
5–11 y $49
12-17 y $49
Vaccination-related adverse events
Physician visit for injection site reaction††† $61 $30–$683
Anaphylaxis‡‡‡ $2,700 $52–$13,754
Guillain-Barré syndrome§§§ $23,360 $6,700–$78,900

*OTC, over the counter; IIV, inactivated influenza vaccine; LAIV, live, attenuated influenza vaccine.
†Vary by age, calculated by costing out recommended dose of acetaminophen for average weight in each age group.
‡Only a proportion of children with influenza illness are assumed to make a physician visit. ICD-9 codes: 487 and 487.0.
§Costs of physician visits for otitis media and nonhospitalized pneumonia vary by age group and include prescription medications and laboratory tests. Costs shown are for children 6–23 mo. See Appendix for full list of costs by age.
¶ICD-9 codes: 460-466, 471-474, 477, 478, 480-483, 490-496, 506-508, 510, 511, 514, 518, 519.
#Includes costs of lifetime care and special education.
**2 doses assumed for children <5 y receiving their first influenza vaccination.
††Vaccine dose costs are based on 2004 CDC-negotiated prices. Cost for children <3 y assumes thimerosal-free vaccine is used.
‡‡Current Procedural Terminology (CPT) codes: 99211 for an additional visit ($19.95) and 90471 for a vaccination at an existing visit ($10.37).
§§Each physician visit is assumed to take 2 hours of parent time valued at an average hourly wage rate of $15.54.
¶¶Proportion of children requiring 2 doses is 1 for 6–23 mo, 0.5 for 2 y, and 0.33 for 3–4 y. No. of additional visits needed to administer recommended number of vaccine doses is 1.07 for 6–23 mo, 0.91 for 2 y, and 0.84 for 3–4 y, and 0.75 for 5–17 y. See Appendix for more details. Total vaccination costs in Table 1 exclude average costs for vaccination-related adverse events of $0.18–$2.05 per child, depending on age and risk status.
##5-minute visit, CPT code 99211.
***ICD-9 codes: 999.4, 995.0, 995.6x.
†††ICD-9 code: 357.0.

*OTC, over the counter; IIV, inactivated influenza vaccine; LAIV, live, attenuated influenza vaccine.
†Vary by age, calculated by costing out recommended dose of acetaminophen for average weight in each age group.
‡Only a proportion of children with influenza illness are assumed to make a physician visit. ICD-9 codes: 487 and 487.0.
§Costs of physician visits for otitis media and nonhospitalized pneumonia vary by age group and include prescription medications and laboratory tests. Costs shown are for children 6–23 mo. See Appendix for full list of costs by age.
¶ICD-9 codes: 460-466, 471-474, 477, 478, 480-483, 490-496, 506-508, 510, 511, 514, 518, 519.
#Includes costs of lifetime care and special education.
**2 doses assumed for children <5 y receiving their first influenza vaccination.
††Vaccine dose costs are based on 2004 CDC-negotiated prices. Cost for children <3 y assumes thimerosal-free vaccine is used.
‡‡Current Procedural Terminology (CPT) codes: 99211 for an additional visit ($19.95) and 90471 for a vaccination at an existing visit ($10.37).
§§Each physician visit is assumed to take 2 hours of parent time valued at an average hourly wage rate of $15.54.
¶¶Proportion of children requiring 2 doses is 1 for 6–23 mo, 0.5 for 2 y, and 0.33 for 3–4 y. No. of additional visits needed to administer recommended number of vaccine doses is 1.07 for 6–23 mo, 0.91 for 2 y, and 0.84 for 3–4 y, and 0.75 for 5–17 y. See Appendix for more details. Total vaccination costs in Table 1 exclude average costs for vaccination-related adverse events of $0.18–$2.05 per child, depending on age and risk status.
##5-minute visit, CPT code 99211.
***ICD-9 codes: 999.4, 995.0, 995.6x.
†††ICD-9 code: 357.0.

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