title: An incremental economic evaluation of targeted and universal influenza vaccination in pregnant women.
abstract: OBJECTIVE
  Pregnancy is associated with increased influenza hospitalizations and physician visits (events) in healthy women and those with co-morbidities. Annual influenza immunization is recommended for all pregnant women. Although vaccination is expected to reduce influenza-related events, the economic implications are unclear. We developed an economic model to estimate the cost-effectiveness (CE) of different vaccination strategies in Nova Scotia.
  
  
  METHODS
  A decision tree characterized the one-year costs and consequences of targeted (pregnant women with co-morbidities only) and universal (all pregnant women) vaccination strategies relative to a no-vaccination strategy. Baseline event probabilities, vaccine effectiveness, costs and quality-of-life weights were derived from individual-level Nova Scotia administrative databases, health system sources and published reports. Sensitivity analyses tested the impact of varying key parameters, including vaccine effectiveness and mode of delivery.
  
  
  RESULTS
  Targeted vaccination was cost-saving relative to no vaccination when delivered by public health clinics (PHC) or routine family practitioner (FP) visit. Cost per quality-adjusted life year gained by universal vaccination relative to targeted strategy was < $40,000 when delivered by PHC or routine FP visit. Net cost of universal vaccination by PHC or a routine FP visit was < $10 per pregnant woman.
  
  
  CONCLUSIONS
  Universal vaccination of pregnant women appears cost-effective when delivered by PHC or as part of a routine FP prenatal visit. Targeted vaccination of pregnant women with co-morbidities can be cost-saving, but the possibility of higher vaccine uptake with a universal compared to a targeted strategy must be considered in addition to costs in program planning.
authors.affiliation: Canadian Center for Vaccinology, IWK Health Centre, Capital District Health Authority and Dalhousie University, Halifax, NS. chris.skedgel@cdha.nshealth.ca
authors.forename: Chris
authors.initials: C
authors.lastname: Skedgel
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Langley
authors.forename: Noni E
authors.initials: NE
authors.lastname: MacDonald
authors.forename: Jeff
authors.initials: J
authors.lastname: Scott
authors.forename: Shelly
authors.initials: S
authors.lastname: McNeil
mesh_terms: D015897:Comorbidity; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage / Q000191:economics*; D007251:Influenza, Human / Q000191:economics* / Q000276:immunology / Q000517:prevention & control; D018803:Models, Economic; D009674:Nova Scotia; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000191:economics* / Q000276:immunology / Q000517:prevention & control; D037841:Pregnant People; D019057:Quality-Adjusted Life Years
chemical_list: D007252:Influenza Vaccines