title: Cost-effectiveness of a recommendation of universal mass vaccination for seasonal influenza in the United States.
abstract: OBJECTIVE
  We evaluated the cost-effectiveness of universal mass vaccination (UMV) against influenza compared with a targeted vaccine program (TVP) for selected age and risk groups in the United States.
  
  
  METHODS
  We modeled costs and outcomes of seasonal influenza with UMV and TVP, taking a societal perspective. The US population was stratified to model age-specific (< 5, 5-17, 18-49, 50-64, and 65+ years) vaccine coverage and efficacy. Probability of influenza-related illness (ILI) and complications, health-care utilization, costs, and survival were estimated. For a season's intervention, ILI cases in that year, lifetime costs (2008 US$), and quality-adjusted life years (QALYs) lost (both discounted at 3% per annum) were calculated for each policy and used to derive incremental cost-effectiveness ratios. A range of sensitivity and alternative-scenario analyses were conducted.
  
  
  RESULTS
  In base-case analyses, TVP resulted in 63 million ILI cases, 859,000 QALYs lost, and $114.5 billion in direct and indirect costs; corresponding estimates for UMV were 61 million cases, 825,000 QALYs lost, and $111.4 billion. UMV was therefore estimated to dominate TVP, saving $3.1 billion and 34,000 QALYs. In probabilistic sensitivity analyses, UMV was dominant in 82% and dominated in 0% of iterations. In alternative-scenario analyses, UMV dominated TVP when lower estimates of vaccine coverage were used. Lower estimates of ILI risk among unvaccinated, vaccine effectiveness, and risk of complications resulted in ICERs of $2800, $8100, and $15,900 per QALY gained, respectively, for UMV compared with TVP.
  
  
  CONCLUSIONS
  UMV against seasonal influenza is cost saving in the United States under reasonable assumptions for coverage, cost, and efficacy.
authors.affiliation: OptumInsight, Medford, MA 02155, USA. karen.clements@i3innovus.com
authors.forename: Karen M
authors.initials: KM
authors.lastname: Clements
authors.forename: Jeremy
authors.initials: J
authors.lastname: Chancellor
authors.forename: Kristin
authors.initials: K
authors.lastname: Nichol
authors.forename: Kelly
authors.initials: K
authors.lastname: DeLong
authors.forename: David
authors.initials: D
authors.lastname: Thompson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage* / Q000191:economics*; D007251:Influenza, Human / Q000191:economics* / Q000401:mortality / Q000517:prevention & control*; D032541:Mass Vaccination / Q000191:economics*; D008875:Middle Aged; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D014481:United States; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines