Volume 5, Number 5—October 1999
The Economic Impact of Pandemic Influenza in the United States: Priorities for Intervention
|Item||Probability of side effectb||Cost of case of side effect ($)b||Lower-cost scenario ($/patient)||Upper-cost scenario ($/patient)|
|Assumed cost of vaccinationa (excluding side effects)||18||59|
|Total cost per patient||21.26||62.26|
aThe cost of vaccination includes the cost of the vaccine, the cost of administering the vaccine, value of time spent by a person traveling to and from the place of vaccination, and patient-associated travel costs. Included in the costs of the vaccine are any costs associated with the rapid production of a larger-than-usual number of doses and the rapid delivery and correct storage of doses at vaccination sites around the country. For $18, the costs were assumed to be $10 for vaccine + administration, $4 patient time (half hour), $4 patient travel costs. For $59, the costs were assumed to be $20 for vaccine + administration (this could include the cost of two doses), $32 patient time (two trips at 2 hours per trip), and $7 patient travel costs. For comparison, a review of 10 published articles found a range of $5 to $22 per dose of vaccine, with a medium [sic] cost of $14 per dose (10). Additional details are provided in the background paper (see methods section). These breakdowns are illustrations only of what might be deemed reasonable estimates of time and cost. Actual costs might vary substantially and will depend on the number of doses needed to achieve a satisfactory protective response, as well as the efficiency of giving vaccinations to millions of persons.
bProbabilities and average cost of treating each category of side effect were derived from (3).
cMild side effects include sore arms due to vaccination, headaches, and other minor side effects that may require a visit to a physician or may cause the patient to miss 1 to 2 days of work.
dGBS = Guillain Barré syndrome.
- Patriarca PA, Cox NJ. Influenza pandemic preparedness plan for the United States. J Infect Dis. 1997;176(Suppl 1):S4–7.
- Simonsen L, Clarke MJ, Schonberger LB, Arden NH, Cox NJ, Fukuda K. Pandemic versus epidemic influenza mortality: a pattern of changing age distribution. J Infect Dis. 1998;178:53–60.
- Office of Technology Assessment. U.S. Congress. Cost effectiveness of influenza vaccination. Washington: Government Printing Office; 1981.
- Kavet J. A perspective on the significance of pandemic influenza. Am J Public Health. 1977;67:1063–70.
- Campbell DS, Rumley MA. Cost-effectiveness of the influenza vaccine in a healthy, working-age population. J Occup Environ Med. 1997;39:408–14.
- Carrat F, Valleron A-J. Influenza mortality among the elderly in France, 1980-90: how many deaths may have been avoided through vaccination? J Epidemiol Community Health. 1995;49:419–25.
- Riddiough MA, Sisk JE, Bell JC. Influenza vaccination: cost-effectiveness and public policy. JAMA. 1983;249:3189–95.
- Patriarca PA, Arden NH, Koplan JP, Goodman RA. Prevention and control of type A influenza infections in nursing homes: benefits and costs of four approaches using vaccination and amantadine. Ann Intern Med. 1987;107:732–40.
- Schoenbaum SC. Economic impact of influenza: the individuals perspective. Am J Med. 1987;82(Supp 6A):26–30.
- Jefferson T, Demicheli V. Socioeconomics of influenza. In: Nicholson KG, Webster RG, Hay AJ, editors. Textbook of influenza. London (UK): Blackwell Science; 1998. p. 541-7.
- Schoenbaum SC, McNeil BJ, Kavet J. The swine-influenza decision. N Engl J Med. 1976;295:759–65.
- Cliff AD, Haggett P. Statistical modelling of measles and influenza outbreaks. Stat Methods Med Res. 1993;2:43–73.
- Critchfield GC, Willard KE. Probabilistic analysis of decision trees using Monte Carlo simulation. Med Decis Making. 1986;6:85–92.
- Dobilet P, Begg CB, Weinstein MC, Braun P, McNeil BJ. Probabilistic sensitivity analysis using Monte Carlo simulation: a practical approach. Med Decis Making. 1985;5:157–77.
- Dittus RS, Roberts SD, Wilson JR. Quantifying uncertainty in medical decisions. J Am Coll Cardiol. 1989;14:23A–8.
- U.S. Bureau of the Census. Statistical abstract of the United States: 1997. 117th ed. Washington: The Bureau; 1997.
- Centers for Disease Control and Prevention. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 1998;47(RR-6):1–26.
- Evans M, Hastings N, Peacock B. Statistical distributions. 2nd ed. New York: John Wiley; 1993.
- Glezen PW. Emerging infections: pandemic influenza. Epidemiol Rev. 1996;18:64–76.
- Mullooly JP, Barker WH. Impact of type A influenza on children: a retrospective study. Am J Public Health. 1982;72:1008–16.
- Barker WH, Mullooly JP. Impact of epidemic type A influenza in a defined adult population. Am J Epidemiol. 1980;112:798–813.
- Simonsen L, Clarke MJ, Williamson GD, Stroup DF, Arden NH, Schonberger LB. The impact of influenza epidemics on mortality: introducing a severity index. Am J Public Health. 1997;87:1944–50.
- Fox JP, Hall CE, Cooney MK, Foy HM. Influenzavirus infections in Seattle families, 1975-1979. I. Study design, methods and the occurrence of infections by time and age. Am J Epidemiol. 1982;116:212–27.
- Glezen WP, Decker M, Joseph SW, Mercready RG. Acute respiratory disease associated with influenza epidemics in Houston, 1981-1983. J Infect Dis. 1987;155:1119–26.
- Serfling RE. Sherman Il, Houseworth WJ. Excess pneumonia-influenza mortality by age and sex in three major influenza A2 epidemics, United States, 1957-58, 1960 and 1963. Am J Epidemiol. 1967;86:433–41.
- Barker WH, Mullooly JP. Pneumonia and influenza deaths during epidemics: implications for prevention. Arch Intern Med. 1982;142:85–9.
- Glezen WP, Payne AA, Snyder DN, Downs TD. Mortality and influenza. J Infect Dis. 1982;146:313–21.
- McBean AM, Babish JD, Warren JL. The impact and cost of influenza in the elderly. Arch Intern Med. 1993;153:2105–11.
- Barker WH. Excess pneumonia and influenza associated hospitalization during influenza epidemics in the United States, 1970-78. Am J Public Health. 1986;76:761–5.
- Haddix AC, Teutsch SM, Shaffer PA, Dunet DO. Prevention effectiveness. New York: Oxford University Press; 1996.
- Fed Regist. 1996;61:46301–2.
- Kaufmann AF, Meltzer MI, Schmid GP. The economic impact of a bioterrorist attack: are prevention and postattack intervention programs justifiable? Emerg Infect Dis. 1997;3:83–94.
- Robinson LJ, Barry PJ. The competitive firm's response to risk. New York: Macmillian; 1987.
- Neustadt RE, Fineberg HV. The swine flu affair: decision making on a slippery disease. Washington: U.S. Department of Health Education, and Welfare; 1978.