title: Economic appraisal of Ontario's Universal Influenza Immunization Program: a cost-utility analysis.
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).
  
  
  RESULTS
  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.
authors.affiliation: Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. bsander@uhnres.utoronto.ca
authors.forename: Beate
authors.initials: B
authors.lastname: Sander
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Kwong
authors.forename: Chris T
authors.initials: CT
authors.lastname: Bauch
authors.forename: Andreas
authors.initials: A
authors.lastname: Maetzel
authors.forename: Allison
authors.initials: A
authors.lastname: McGeer
authors.forename: Janet M
authors.initials: JM
authors.lastname: Raboud
authors.forename: Murray
authors.initials: M
authors.lastname: Krahn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis / Q000379:methods*; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D007252:Influenza Vaccines / Q000191:economics* / Q000627:therapeutic use; D008875:Middle Aged; D009864:Ontario; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines
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