Anderson LJ, Shekelle P, Keeler E, et al. The Cost of Interventions to Increase Influenza Vaccination: A Systematic Review. Am J Prev Med. 2018 Feb;54(2):299-315. doi: 10.1016/j.amepre.2017.11.010. Epub 2018 Jan 18.
Discipline Area Score
Nurse 6 / 7
Physician 5 / 7

CONTEXT: Influenza vaccination rates remain below Healthy People 2020 goals. This project sought to systematically review economic evaluations of healthcare-based quality improvement interventions for improving influenza vaccination uptake among general populations and healthcare workers.

EVIDENCE ACQUISITION: The databases MEDLINE, Econlit, Centre for Reviews & Dissemination, Greylit, and Worldcat were searched in July 2016 for papers published from January 2004 to July 2016. Eligible studies evaluated efforts by bodies within the healthcare system to encourage influenza vaccination by means of an organizational or structural change. For each study, program costs per enrollee and per additional enrollee vaccinated were derived (excluding vaccine costs, standardized to 2017 U.S. dollars). Complete economic evaluations were examined when available.

EVIDENCE SYNTHESIS: Of 2,350 records, 18 articles were eligible and described 29 unique interventions. Most interventions improved vaccine uptake. Among 23 interventions in general populations, the median program cost was $3.27 (interquartile range, $0.82-$11.53) per enrollee and $50.78 (interquartile range, $27.85-$124.84) per additional enrollee vaccinated. Among ten complete economic evaluations in general populations, three studies reported net cost savings, four reported costs <$50,000 per quality-adjusted life year, and three reported costs <$60,000 per life saved. Among six interventions in healthcare workers, the median program cost was $8.09 (interquartile range, $5.03-$10.31) per worker enrolled and $125.24 (interquartile range, $96.06-$171.38) per additional worker vaccinated (there were no complete economic analyses).

CONCLUSIONS: Quality improvement interventions for influenza vaccination involve per-enrollee costs that are similar to the cost of the vaccine itself ($11.78-$36.08/dose). Based on limited available evidence in general populations, quality improvement interventions may be cost saving to cost effective for the health system.

Comments from MORE raters

Nurse rater

This is a good economic review. It follows a systematic review of economic studies process clearly.

Nurse rater

Though some of the interventions were the same, it could not be completely compared to UK flu vaccine programme. Cost will also differ due to the different health systems and government targets!

Nurse rater

This is an excellent analysis of interventions to encourage influenza vaccination. It would be interesting to see the results of these interventions if they were applied to pneumonia and other vaccinations across populations.

Physician rater

Although this paper is important for policy, it's not particularly relevant for clinical practice per se.

Physician rater

This interesting study reviews various strategies to increase influenza immunization. The interventions were highly varied and had quite different rates of success. Leaving aside for a moment the merits of vaccination (which shift year by year based on the circulating strain), it should be possible to increase the rate of vaccination with low cost measures. There may be even greater gains to be made with more aggressive forms of persuasion, but most offices and government agencies are not equipped to work that hard for this health goal. This effort is probably useful and cost-effective, but it is equally important to strive for better vaccines since the time and financial overhead to enhance vaccination rates must be repeated annually.
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