Economic Appraisal of Ontario's Universal Influenza Immunization Program: A Cost-Utility Analysis
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{"title"=>"Economic appraisal of Ontario's universal influenza immunization program: A cost-utility analysis", "type"=>"journal", "authors"=>[{"first_name"=>"Beate", "last_name"=>"Sander", "scopus_author_id"=>"35825473000"}, {"first_name"=>"Jeffrey C.", "last_name"=>"Kwong", "scopus_author_id"=>"7005301949"}, {"first_name"=>"Chris T.", "last_name"=>"Bauch", "scopus_author_id"=>"35619116700"}, {"first_name"=>"Andreas", "last_name"=>"Maetzel", "scopus_author_id"=>"56334258000"}, {"first_name"=>"Allison", "last_name"=>"McGeer", "scopus_author_id"=>"7006664445"}, {"first_name"=>"Janet M.", "last_name"=>"Raboud", "scopus_author_id"=>"7005531435"}, {"first_name"=>"Murray", "last_name"=>"Krahn", "scopus_author_id"=>"7005004050"}], "year"=>2010, "source"=>"PLoS Medicine", "identifiers"=>{"issn"=>"15491277", "scopus"=>"2-s2.0-77951757376", "sgr"=>"77951757376", "pui"=>"358744946", "isbn"=>"1549-1676 (Electronic) 1549-1277 (Linking)", "pmid"=>"20386727", "doi"=>"10.1371/journal.pmed.1000256"}, "id"=>"25be777c-cb29-3201-b0a1-7fc79165c541", "abstract"=>"BACKGROUND: In July 2000, the province of Ontario, Canada, initiated a universal influenza immunization program (UIIP) to provide free seasonal influenza vaccines for the entire population. This is the first large-scale program of its kind worldwide. The objective of this study was to conduct an economic appraisal of Ontario's UIIP compared to a targeted influenza immunization program (TIIP). METHODS AND FINDINGS: A cost-utility analysis using Ontario health administrative data was performed. The study was informed by a companion ecological study comparing physician visits, emergency department visits, hospitalizations, and deaths between 1997 and 2004 in Ontario and nine other Canadian provinces offering targeted immunization programs. The relative change estimates from pre-2000 to post-2000 as observed in other provinces were applied to pre-UIIP Ontario event rates to calculate the expected number of events had Ontario continued to offer targeted immunization. Main outcome measures were quality-adjusted life years (QALYs), costs in 2006 Canadian dollars, and incremental cost-utility ratios (incremental cost per QALY gained). Program and other costs were drawn from Ontario sources. Utility weights were obtained from the literature. The incremental cost of the program per QALY gained was calculated from the health care payer perspective. Ontario's UIIP costs approximately twice as much as a targeted program but reduces influenza cases by 61% and mortality by 28%, saving an estimated 1,134 QALYs per season overall. Reducing influenza cases decreases health care services cost by 52%. Most cost savings can be attributed to hospitalizations avoided. The incremental cost-effectiveness ratio is Can$10,797/QALY gained. Results are most sensitive to immunization cost and number of deaths averted. CONCLUSIONS: Universal immunization against seasonal influenza was estimated to be an economically attractive intervention.", "link"=>"http://www.mendeley.com/research/economic-appraisal-ontarios-universal-influenza-immunization-program-costutility-analysis-5", "reader_count"=>65, "reader_count_by_academic_status"=>{"Unspecified"=>1, "Professor > Associate Professor"=>5, "Researcher"=>10, "Student > Ph. D. Student"=>12, "Student > Postgraduate"=>3, "Other"=>6, "Student > Master"=>19, "Student > Bachelor"=>3, "Lecturer"=>2, "Lecturer > Senior Lecturer"=>2, "Professor"=>2}, "reader_count_by_user_role"=>{"Unspecified"=>1, "Professor > Associate Professor"=>5, "Researcher"=>10, "Student > Ph. D. Student"=>12, "Student > Postgraduate"=>3, "Other"=>6, "Student > Master"=>19, "Student > Bachelor"=>3, "Lecturer"=>2, "Lecturer > Senior Lecturer"=>2, "Professor"=>2}, "reader_count_by_subject_area"=>{"Unspecified"=>7, "Agricultural and Biological Sciences"=>9, "Arts and Humanities"=>1, "Business, Management and Accounting"=>2, "Chemical Engineering"=>1, "Computer Science"=>1, "Decision Sciences"=>1, "Economics, Econometrics and Finance"=>2, "Environmental Science"=>2, "Biochemistry, Genetics and Molecular Biology"=>1, "Nursing and Health Professions"=>2, "Mathematics"=>3, "Medicine and Dentistry"=>25, "Psychology"=>2, "Social Sciences"=>5, "Immunology and Microbiology"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>25}, "Social Sciences"=>{"Social Sciences"=>5}, "Decision Sciences"=>{"Decision Sciences"=>1}, "Psychology"=>{"Psychology"=>2}, "Mathematics"=>{"Mathematics"=>3}, "Unspecified"=>{"Unspecified"=>7}, "Environmental Science"=>{"Environmental Science"=>2}, "Chemical Engineering"=>{"Chemical Engineering"=>1}, "Arts and Humanities"=>{"Arts and Humanities"=>1}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>2}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>9}, "Computer Science"=>{"Computer Science"=>1}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>2}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>2}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>1}}, "reader_count_by_country"=>{"Canada"=>1, "United States"=>2, "Botswana"=>1, "Taiwan"=>1}, "group_count"=>8}

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  • {"files"=>["https://ndownloader.figshare.com/files/425262", "https://ndownloader.figshare.com/files/425291", "https://ndownloader.figshare.com/files/425321", "https://ndownloader.figshare.com/files/425368", "https://ndownloader.figshare.com/files/425418", "https://ndownloader.figshare.com/files/425473", "https://ndownloader.figshare.com/files/425568", "https://ndownloader.figshare.com/files/425621", "https://ndownloader.figshare.com/files/425682", "https://ndownloader.figshare.com/files/425736", "https://ndownloader.figshare.com/files/425777", "https://ndownloader.figshare.com/files/425824", "https://ndownloader.figshare.com/files/425901", "https://ndownloader.figshare.com/files/425954"], "description"=>"<div><h3>Background</h3><p>In July 2000, the province of Ontario, Canada, initiated a universal influenza immunization program (UIIP) to provide free seasonal influenza vaccines for the entire population. This is the first large-scale program of its kind worldwide. The objective of this study was to conduct an economic appraisal of Ontario's UIIP compared to a targeted influenza immunization program (TIIP).</p><h3>Methods and Findings</h3><p>A cost-utility analysis using Ontario health administrative data was performed. The study was informed by a companion ecological study comparing physician visits, emergency department visits, hospitalizations, and deaths between 1997 and 2004 in Ontario and nine other Canadian provinces offering targeted immunization programs. The relative change estimates from pre-2000 to post-2000 as observed in other provinces were applied to pre-UIIP Ontario event rates to calculate the expected number of events had Ontario continued to offer targeted immunization. Main outcome measures were quality-adjusted life years (QALYs), costs in 2006 Canadian dollars, and incremental cost-utility ratios (incremental cost per QALY gained). Program and other costs were drawn from Ontario sources. Utility weights were obtained from the literature. The incremental cost of the program per QALY gained was calculated from the health care payer perspective. Ontario's UIIP costs approximately twice as much as a targeted program but reduces influenza cases by 61% and mortality by 28%, saving an estimated 1,134 QALYs per season overall. Reducing influenza cases decreases health care services cost by 52%. Most cost savings can be attributed to hospitalizations avoided. The incremental cost-effectiveness ratio is Can$10,797/QALY gained. Results are most sensitive to immunization cost and number of deaths averted.</p><h3>Conclusions</h3><p>Universal immunization against seasonal influenza was estimated to be an economically attractive intervention.</p><h3></h3><p><em>Please see later in the article for the Editors' Summary</em></p></div>", "links"=>[], "tags"=>["appraisal", "influenza", "immunization", "cost-utility"], "article_id"=>143948, "categories"=>["Medicine", "Cancer", "Information And Computing Sciences"], "users"=>["Beate Sander", "Jeffrey C. Kwong", "Chris T. Bauch", "Andreas Maetzel", "Allison McGeer", "Janet M. Raboud", "Murray Krahn"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1000256.s001", "https://dx.doi.org/10.1371/journal.pmed.1000256.s002", "https://dx.doi.org/10.1371/journal.pmed.1000256.s003", "https://dx.doi.org/10.1371/journal.pmed.1000256.s004", "https://dx.doi.org/10.1371/journal.pmed.1000256.s005", "https://dx.doi.org/10.1371/journal.pmed.1000256.s006", "https://dx.doi.org/10.1371/journal.pmed.1000256.s007", "https://dx.doi.org/10.1371/journal.pmed.1000256.s008", "https://dx.doi.org/10.1371/journal.pmed.1000256.s009", "https://dx.doi.org/10.1371/journal.pmed.1000256.s010", "https://dx.doi.org/10.1371/journal.pmed.1000256.s011", "https://dx.doi.org/10.1371/journal.pmed.1000256.s012", "https://dx.doi.org/10.1371/journal.pmed.1000256.s013", "https://dx.doi.org/10.1371/journal.pmed.1000256.s014"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Economic_Appraisal_of_Ontario_s_Universal_Influenza_Immunization_Program_A_Cost_Utility_Analysis/143948", "title"=>"Economic Appraisal of Ontario's Universal Influenza Immunization Program: A Cost-Utility Analysis", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2010-04-06 01:05:48"}
  • {"files"=>["https://ndownloader.figshare.com/files/855064"], "description"=>"<p>The grey vertical line corresponds to all the uncertain parameters being at their respective base values. The width of the bars indicates the uncertainty associated with each parameter (ranging from lower to upper limit). The red segments of the bars correspond to result values increasing the base case ICER, and the blue segments of the bars correspond to result values decreasing the base case ICER. ED, emergency department; QALY, quality-adjusted life year; RR, relative rate; TIIP, targeted influenza immunization program; UIIP, universal influenza immunization program.</p>", "links"=>[], "tags"=>["diagram", "comparing"], "article_id"=>525517, "categories"=>["Medicine", "Infectious Diseases", "Information And Computing Sciences"], "users"=>["Beate Sander", "Jeffrey C. Kwong", "Chris T. Bauch", "Andreas Maetzel", "Allison McGeer", "Janet M. Raboud", "Murray Krahn"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1000256.g001"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Tornado_diagram_comparing_the_relative_importance_of_variables_/525517", "title"=>"Tornado diagram comparing the relative importance of variables.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2010-04-06 01:31:57"}
  • {"files"=>["https://ndownloader.figshare.com/files/855134"], "description"=>"<p>Incremental cost acceptability curve.</p>", "links"=>[], "tags"=>["acceptability"], "article_id"=>525591, "categories"=>["Medicine", "Infectious Diseases", "Information And Computing Sciences"], "users"=>["Beate Sander", "Jeffrey C. Kwong", "Chris T. Bauch", "Andreas Maetzel", "Allison McGeer", "Janet M. Raboud", "Murray Krahn"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1000256.g002"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Incremental_cost_acceptability_curve_/525591", "title"=>"Incremental cost acceptability curve.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2010-04-06 01:33:11"}
  • {"files"=>["https://ndownloader.figshare.com/files/855222"], "description"=>"<p>Source: Kwong <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000256#pmed.1000256-Kwong1\" target=\"_blank\">[13]</a>.</p><p>CI, confidence interval; ED, emergency department; UIIP, universal influenza immunization program.</p>", "links"=>[], "tags"=>["influenza-related", "rates", "comparing", "post-uiip", "pre-uiip"], "article_id"=>525669, "categories"=>["Medicine", "Infectious Diseases", "Information And Computing Sciences"], "users"=>["Beate Sander", "Jeffrey C. Kwong", "Chris T. Bauch", "Andreas Maetzel", "Allison McGeer", "Janet M. Raboud", "Murray Krahn"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1000256.t001"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Mean_annual_influenza_related_event_rates_and_relative_rates_comparing_post_UIIP_to_pre_UIIP_event_rates_/525669", "title"=>"Mean annual influenza-related event rates and relative rates comparing post-UIIP to pre-UIIP event rates.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-04-06 01:34:29"}
  • {"files"=>["https://ndownloader.figshare.com/files/855263"], "description"=>"<p>Source: quality of life with influenza: Turner <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000256#pmed.1000256-Turner1\" target=\"_blank\">[16]</a>; life expectancy: Statistics Canada <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000256#pmed.1000256-5\" target=\"_blank\">[19]</a>; quality of life adjustment by age in the absence of influenza: Mittmann <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000256#pmed.1000256-Mittmann1\" target=\"_blank\">[20]</a>; office visits, ED visits, hospitalizations: Ontario Health Insurance Plan (OHIP) dataset; TIIP: calculated based on influenza immunization program cost before implementation of UIIP, vaccine coverage rates in Ontario pre-UIIP, and relative increase of influenza immunization coverage in other provinces <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000256#pmed.1000256-Kwong1\" target=\"_blank\">[13]</a>,<a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000256#pmed.1000256-Kunji1\" target=\"_blank\">[56]</a> (Nancy Peroff-Johnston, MOHLTC, personal communication, May 11, 2007); UIIP: Ministry of Health and Long-Term Care <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000256#pmed.1000256-Kunji1\" target=\"_blank\">[56]</a> (Nancy Peroff-Johnston, MOHLTC, personal communication, May 11, 2007).</p><p>ED, emergency department; TIIP, targeted influenza immunization program; UIIP, universal influenza immunization program.</p>", "links"=>[], "tags"=>["infectious diseases/viral infections", "public health and epidemiology/health policy", "public health and epidemiology/health services research and economics", "public health and epidemiology/immunization", "public health and epidemiology/preventive medicine"], "article_id"=>525710, "categories"=>["Medicine", "Infectious Diseases", "Information And Computing Sciences"], "users"=>["Beate Sander", "Jeffrey C. Kwong", "Chris T. Bauch", "Andreas Maetzel", "Allison McGeer", "Janet M. Raboud", "Murray Krahn"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1000256.t002"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Key_data_used_in_the_economic_evaluation_/525710", "title"=>"Key data used in the economic evaluation.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-04-06 01:35:10"}
  • {"files"=>["https://ndownloader.figshare.com/files/855304"], "description"=>"<p>ED, emergency department; ICER, incremental cost-effectiveness ratio; $M, $ million; QALY, quality-adjusted life years; TIIP, targeted influenza immunization program; UIIP, universal influenza immunization program.</p>", "links"=>[], "tags"=>["infectious diseases/viral infections", "public health and epidemiology/health policy", "public health and epidemiology/health services research and economics", "public health and epidemiology/immunization", "public health and epidemiology/preventive medicine"], "article_id"=>525751, "categories"=>["Medicine", "Infectious Diseases", "Information And Computing Sciences"], "users"=>["Beate Sander", "Jeffrey C. Kwong", "Chris T. Bauch", "Andreas Maetzel", "Allison McGeer", "Janet M. Raboud", "Murray Krahn"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1000256.t003"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Results_8212_base_case_/525751", "title"=>"Results—base case.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-04-06 01:35:51"}
  • {"files"=>["https://ndownloader.figshare.com/files/855349"], "description"=>"a<p>Discounted at an annual rate of 3%.</p><p>$M, $ million; QALY, quality-adjusted life years.</p>", "links"=>[], "tags"=>["infectious diseases/viral infections", "public health and epidemiology/health policy", "public health and epidemiology/health services research and economics", "public health and epidemiology/immunization", "public health and epidemiology/preventive medicine"], "article_id"=>525797, "categories"=>["Medicine", "Infectious Diseases", "Information And Computing Sciences"], "users"=>["Beate Sander", "Jeffrey C. Kwong", "Chris T. Bauch", "Andreas Maetzel", "Allison McGeer", "Janet M. Raboud", "Murray Krahn"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1000256.t004"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Results_8212_probabilistic_sensitivity_analysis_/525797", "title"=>"Results—probabilistic sensitivity analysis.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-04-06 01:36:37"}

PMC Usage Stats | Further Information

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  • {"unique-ip"=>"36", "full-text"=>"42", "pdf"=>"16", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"1", "cited-by"=>"2", "year"=>"2015", "month"=>"11"}
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  • {"unique-ip"=>"17", "full-text"=>"17", "pdf"=>"6", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"9"}
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  • {"unique-ip"=>"7", "full-text"=>"7", "pdf"=>"3", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"12"}
  • {"unique-ip"=>"11", "full-text"=>"8", "pdf"=>"1", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"1"}
  • {"unique-ip"=>"13", "full-text"=>"16", "pdf"=>"2", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"11", "cited-by"=>"0", "year"=>"2017", "month"=>"2"}
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  • {"unique-ip"=>"16", "full-text"=>"18", "pdf"=>"6", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"3"}
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  • {"unique-ip"=>"9", "full-text"=>"9", "pdf"=>"2", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"6"}
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  • {"unique-ip"=>"5", "full-text"=>"6", "pdf"=>"1", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"5", "cited-by"=>"0", "year"=>"2018", "month"=>"9"}
  • {"unique-ip"=>"17", "full-text"=>"20", "pdf"=>"3", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"10"}
  • {"unique-ip"=>"17", "full-text"=>"21", "pdf"=>"7", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"14", "cited-by"=>"0", "year"=>"2018", "month"=>"11"}
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  • {"unique-ip"=>"6", "full-text"=>"6", "pdf"=>"2", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"2"}
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  • {"unique-ip"=>"9", "full-text"=>"10", "pdf"=>"4", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"2", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"4"}
  • {"unique-ip"=>"7", "full-text"=>"11", "pdf"=>"2", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"4", "cited-by"=>"0", "year"=>"2019", "month"=>"5"}
  • {"unique-ip"=>"4", "full-text"=>"3", "pdf"=>"1", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"8"}
  • {"unique-ip"=>"9", "full-text"=>"8", "pdf"=>"2", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"9"}
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Relative Metric

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