title: Cost effectiveness analysis of Year 2 of an elementary school-located influenza vaccination program-Results from a randomized controlled trial.
abstract: BACKGROUND
  School-located vaccination against influenza (SLV-I) has the potential to improve current suboptimal influenza immunization coverage for U.S. school-aged children. However, little is known about SLV-I's cost-effectiveness. The objective of this study is to establish the cost-effectiveness of SLV-I based on a two-year community-based randomized controlled trial (Year 1: 2009-2010 vaccination season, an unusual H1N1 pandemic influenza season, and Year 2: 2010-2011, a more typical influenza season).
  
  
  METHODS
  We performed a cost-effectiveness analysis on a two-year randomized controlled trial of a Western New York SLV-I program. SLV-I clinics were offered in 21 intervention elementary schools (Year 1 n = 9,027; Year 2 n = 9,145 children) with standard-of-care (no SLV-I) in control schools (Year 1 n = 4,534 (10 schools); Year 2 n = 4,796 children (11 schools)). We estimated the cost-per-vaccinated child, by dividing the incremental cost of the intervention by the incremental effectiveness (i.e., the number of additionally vaccinated students in intervention schools compared to control schools).
  
  
  RESULTS
  In Years 1 and 2, respectively, the effectiveness measure (proportion of children vaccinated) was 11.2 and 12.0 percentage points higher in intervention (40.7 % and 40.4 %) than control schools. In year 2, the cost-per-vaccinated child excluding vaccine purchase ($59.88 in 2010 US $) consisted of three component costs: (A) the school costs ($8.25); (B) the project coordination costs ($32.33); and (C) the vendor costs excluding vaccine purchase ($16.68), summed through Monte Carlo simulation. Compared to Year 1, the two component costs (A) and (C) decreased, while the component cost (B) increased in Year 2. The cost-per-vaccinated child, excluding vaccine purchase, was $59.73 (Year 1) and $59.88 (Year 2, statistically indistinguishable from Year 1), higher than the published cost of providing influenza vaccination in medical practices ($39.54). However, taking indirect costs (e.g., averted parental costs to visit medical practices) into account, vaccination was less costly in SLV-I ($23.96 in Year 1, $24.07 in Year 2) than in medical practices.
  
  
  CONCLUSIONS
  Our two-year trial's findings reinforced the evidence to support SLV-I as a potentially favorable system to increase childhood influenza vaccination rates in a cost-efficient way. Increased efficiencies in SLV-I are needed for a sustainable and scalable SLV-I program.
authors.affiliation: Department of Public Health Sciences, University of California Davis, School of Medicine, One Shields Ave. Medical Sciences 1C, Davis, CA, 95616, USA. byoo@ucdavis.edu.
authors.forename: Byung-Kwang
authors.initials: BK
authors.lastname: Yoo
authors.affiliation: Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, 64108, USA. Sharon_Humiston@URMC.Rochester.edu.
authors.forename: Sharon G
authors.initials: SG
authors.lastname: Humiston
authors.affiliation: Department of Pediatrics, University of California Los Angeles (UCLA), 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA. PSzilagyi@mednet.ucla.edu.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Szilagyi
authors.affiliation: Department of Pediatrics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave., Rochester, NY, 14642, USA. Stanley_Schaffer@URMC.Rochester.edu.
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Schaffer
authors.affiliation: Center for Community Health of the University of Rochester, 46 Prince Street, Suite 1001, Rochester, NY, 14607, USA. christine_long@urmc.rochester.edu.
authors.forename: Christine
authors.initials: C
authors.lastname: Long
authors.affiliation: Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, 30333, USA. mxk2@cdc.gov.
authors.forename: Maureen
authors.initials: M
authors.lastname: Kolasa
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003132:Commerce / Q000191:economics; D003362:Cost-Benefit Analysis; D006801:Humans; D017589:Immunization Programs / Q000191:economics; D053118:Influenza A Virus, H1N1 Subtype; D007252:Influenza Vaccines / Q000191:economics*; D007251:Influenza, Human / Q000191:economics* / Q000517:prevention & control; D008297:Male; D009010:Monte Carlo Method; D009518:New York; D010290:Parents; D012111:Residence Characteristics; D012572:School Health Services / Q000191:economics; D012621:Seasons; D013334:Students; D014611:Vaccination / Q000191:economics
chemical_list: D007252:Influenza Vaccines