Economic Analysis of Influenza Vaccination and Antiviral Treatment for Healthy Working Adults

20 August 2002 | Volume 137 Issue 4 | Pages 225-231

Background: Physicians have several treatment options for influenza, including vaccination and various antiviral therapies. However, the optimal influenza prevention and treatment strategy is unknown.

Objective: To compare the relative health values of contemporary treatment strategies for influenza in a healthy sample of working adults.

Design: Cost-benefit analysis using a decision model.

Data Sources: Previously published data.

Target Population: Healthy employed adults 18 to 50 years of age.

Time Horizon: A complete influenza season.

Perspective: Societal.

Interventions: Eight treatment options (yes or no) based on the possible combinations of vaccination and antiviral therapy (rimantadine, oseltamivir, or zanamivir or no treatment) should infection develop.

Outcome Measures: Cost in U.S. dollars, including the value of symptom relief and medication side effects, which was assigned a monetary value through a conjoint analysis that used a "willingness-to-pay" approach.

Results: In the base-case analysis, all strategies for influenza vaccination had a higher net benefit than the nonvaccination strategies. Vaccination and use of rimantadine, the most cost-beneficial strategy, was $30.97 more cost-beneficial than nonvaccination and no use of antiviral medication. The health benefits of most antiviral treatments equaled or exceeded their costs for most scenarios. The choice of the most cost-beneficial antiviral strategy was sensitive to the prevalence of influenza B and to the comparative workdays gained by each antiviral therapy.

Conclusions: Vaccination is cost-beneficial in most influenza seasons in healthy working adults. Although the benefits of antiviral therapy for persons with influenza infection appear to justify its cost, head-to-head trials of the various antiviral therapies are needed to determine the optimal treatment strategy.

Editors' Notes Context Strategies to decrease the adverse consequences of influenza include vaccination and antiviral therapy. No previous study has compared these two strategies in healthy working adults. Contribution In this cost–benefit analysis, vaccination strategies resulted in higher net benefits than strategies that did not include vaccination. The health benefits of most antiviral treatments equaled or surpassed their costs. Clinical Implications Vaccinating healthy working adults against influenza is an economically attractive strategy for preventing the adverse consequences of influenza. Antiviral treatment for persons infected with influenza also saves money, but head-to-head comparisons of the available therapies are needed to define the most cost-effective regimen. –The Editors

 

Author and Article Information

From Duke University and the Durham Veterans Affairs Medical Center, Durham, North Carolina.

Acknowledgments: The authors thank the staff of the Triangle Family Practice in Durham, North Carolina, for help with patient surveys. They also thank Patricia Cowper for assistance in obtaining data on U.S. labor wages.

Grant Support: By the National Institutes of Health (NIH Grant T35-GM08679), a grant from the Faculty Challenge Research Program in Health Sector Management, and an Alpha Omega Alpha Student Research Fellowship.

Requests for Single Reprints: Eric D. Peterson, MD, MPH, Duke University Medical Center, Box 3236, Durham, NC 27710; e-mail, peter016{at}mc.duke.edu.

Current Author Addresses: Dr. Lee: Stanford University School of Medicine, Room S101, Department of Medicine, Stanford, CA 94305.

Dr. Matchar: Duke Center for Clinical Health Policy Research, 2200 West Main Street, Durham, NC 27705.

Dr. Clements: Duke University Medical Center, Box 3810, Durham, NC 27710.

Dr. Huber: Fuqua School of Business, Duke University, Box 90120, Durham, NC 27708.

Dr. Hamilton: Duke University Medical Center, Durham, NC 27710.

Dr. Peterson: Duke University Medical Center, Box 3236, Durham, NC 27710.

Author Contributions: Conception and design: P.Y. Lee, D.B. Matchar, J. Huber, J.D. Hamilton, E.D. Peterson.

Analysis and interpretation of the data: P.Y. Lee, D.B. Matchar, D.A. Clements, J. Huber, E.D. Peterson.

Drafting of the article: P.Y. Lee, E.D. Peterson.

Critical revision of the article for important intellectual content: P.Y. Lee, D.B. Matchar, J. Huber, J.D. Hamilton, E.D. Peterson.

Final approval of the article: P.Y. Lee, D.A. Clements, J.D. Hamilton, E.D. Peterson.

Provision of study materials or patients: P.Y. Lee, D.A. Clements, E.D. Peterson.

Statistical expertise: P.Y. Lee, J. Huber.

Obtaining of funding: P.Y. Lee, E.D. Peterson.

Administrative, technical, or logistic support: P.Y. Lee.

Collection and assembly of data: P.Y. Lee, E.D. Peterson.