Effectiveness and Cost-Effectiveness of Vaccination Against Pandemic Influenza (H1N1) 2009

  1. Nayer Khazeni, MD, MS;
  2. David W. Hutton, MS;
  3. Alan M. Garber, MD, PhD;
  4. Nathaniel Hupert, MD, MPH; and
  5. Douglas K. Owens, MD, MS
  1. From Stanford University Medical Center and Stanford University, Stanford, California; Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and Cornell Medical College, New York, New York.

    Abstract

    Background: Decisions on the timing and extent of vaccination against pandemic (H1N1) 2009 virus are complex.

    Objective: To estimate the effectiveness and cost-effectiveness of pandemic influenza (H1N1) vaccination under different scenarios in October or November 2009.

    Design: Compartmental epidemic model in conjunction with a Markov model of disease progression.

    Data Sources: Literature and expert opinion.

    Target Population: Residents of a major U.S. metropolitan city with a population of 8.3 million.

    Time Horizon: Lifetime.

    Perspective: Societal.

    Interventions: Vaccination in mid-October or mid-November 2009.

    Outcome Measures: Infections and deaths averted, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness.

    Results of Base-Case Analysis: Assuming each primary infection causes 1.5 secondary infections, vaccinating 40% of the population in October or November would be cost-saving. Vaccination in October would avert 2051 deaths, gain 69 679 QALYs, and save $469 million compared with no vaccination; vaccination in November would avert 1468 deaths, gain 49 422 QALYs, and save $302 million.

    Results of Sensitivity Analysis: Vaccination is even more cost-saving if longer incubation periods, lower rates of infectiousness, or increased implementation of nonpharmaceutical interventions delay time to the peak of the pandemic. Vaccination saves fewer lives and is less cost-effective if the epidemic peaks earlier than mid-October.

    Limitations: The model assumed homogenous mixing of case-patients and contacts; heterogeneous mixing would result in faster initial spread, followed by slower spread. Additional costs and savings not included in the model would make vaccination more cost-saving.

    Conclusion: Earlier vaccination against pandemic (H1N1) 2009 prevents more deaths and is more cost-saving. Complete population coverage is not necessary to reduce the viral reproductive rate sufficiently to help shorten the pandemic.

    Primary Funding Source: Agency for Healthcare Research and Quality and National Institute on Drug Abuse.

    Article and Author Information

    • Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

    • Acknowledgment: The authors thank the reviewers for their extremely thorough and helpful reviews and suggestions.

    • Grant Support: By the Agency for Healthcare Research and Quality (1 F32 HS018003-01A1, Dr. Khazeni), the National Institute on Drug Abuse (2 R01 DA15612-016, Dr. Owens), a Stanford Graduate Fellowship (Mr. Hutton), and the Department of Veterans Affairs (Drs. Owens and Garber).

    • Potential Conflicts of Interest: None disclosed.

    • Reproducible Research Statement: An annotated version of the model is available in Appendix 1 so that others can test our findings and conclusions.

    • Requests for Single Reprints: Nayer Khazeni, MD, MS, Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, 300 Pasteur Drive, H3143, Stanford CA 94305.

    • Current Author Addresses: Dr. Khazeni: Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, 300 Pasteur Drive, H3143, Stanford, CA 94305.

    • Mr. Hutton: 496 Terman Engineering Center, Stanford University, Stanford, CA 94305.

    • Drs. Garber and Owens: Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University, 117 Encina Commons, Stanford, CA 94305-6019.

    • Dr. Hupert: Departments of Public Health and Medicine, Weill Medical College, Cornell University, 402 East 67th Street, LA-219, New York, NY 10065.

    • Author Contributions: Conception and design: N. Khazeni, D.W. Hutton, A.M. Garber, D.K. Owens.

    • Analysis and interpretation of the data: N. Khazeni, D.W. Hutton, A.M. Garber, N. Hupert, D.K. Owens.

    • Drafting of the article: N. Khazeni, D.W. Hutton, A.M. Garber, N. Hupert, D.K. Owens.

    • Critical revision of the article for important intellectual content: N. Khazeni, D.W. Hutton, A.M. Garber, N. Hupert.

    • Final approval of the article: N. Khazeni, D.W. Hutton, A.M. Garber, N. Hupert, D.K. Owens.

    • Provision of study materials or patients: N. Khazeni.

    • Statistical expertise: N. Khazeni, D.W. Hutton, A.M. Garber, D.K. Owens.

    • Obtaining of funding: N. Khazeni.

    • Administrative, technical, or logistic support: N. Khazeni, A.M. Garber.

    • Collection and assembly of data: N. Khazeni, D.W. Hutton, N. Hupert, D.K. Owens.

    Responses to this article

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    This Article

    1. Published online before print October 5, 2009
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