title: Cost-effectiveness of seasonal inactivated influenza vaccination among pregnant women.
abstract: To evaluate the cost-effectiveness of seasonal inactivated influenza vaccination among pregnant women using data from three recent influenza seasons in the United States.
  
  
  
  We developed a decision-analytic model following a cohort of 5.2 million pregnant women and their infants aged <6 months to evaluate the cost-effectiveness of vaccinating women against seasonal influenza during pregnancy from a societal perspective. The main outcome measures were quality-adjusted life-year (QALY) gained and cost-effectiveness ratios. Data sources included surveillance data, epidemiological studies, and published vaccine cost data. Sensitivity analyses were also performed. All costs and outcomes were discounted at 3% annually.
  
  
  
  Total costs (direct and indirect), effects (QALY gains, averted case numbers), and incremental cost-effectiveness of seasonal inactivated influenza vaccination among pregnant women (cost per QALY gained).
  
  
  
  Using a recent benchmark of 52.2% vaccination coverage among pregnant women, we studied a hypothetical cohort of 2,753,015 vaccinated pregnant women. With an estimated vaccine effectiveness of 73% among pregnant women and 63% among infants <6 months, QALY gains for each season were 305 (2010-2011), 123 (2011-2012), and 610 (2012-2013). Compared with no vaccination, seasonal influenza vaccination during pregnancy was cost-saving when using data from the 2010-2011 and 2012-2013 influenza seasons. The cost-effectiveness ratio was greater than $100,000/QALY with the 2011-2012 influenza season data, when CDC reported a low attack rate compared to other recent seasons.
  
  
  
  Influenza vaccination for pregnant women can reduce morbidity from influenza in both pregnant women and their infants aged <6 months. Seasonal influenza vaccination during pregnancy is cost-saving during moderate to severe influenza seasons.
authors.affiliation: Immunization Service Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, USA. Electronic address: jingxu.emory@gmail.com.
authors.forename: Jing
authors.initials: J
authors.lastname: Xu
authors.affiliation: Immunization Service Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, USA. Electronic address: faz1@cdc.gov.
authors.forename: Fangjun
authors.initials: F
authors.lastname: Zhou
authors.affiliation: Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, USA. Electronic address: ggj2@cdc.gov.
authors.forename: Carrie
authors.initials: C
authors.lastname: Reed
authors.affiliation: Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, USA. Electronic address: bev8@cdc.gov.
authors.forename: Sandra S
authors.initials: SS
authors.lastname: Chaves
authors.affiliation: Immunization Service Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, USA. Electronic address: qzm3@cdc.gov.
authors.forename: Mark
authors.initials: M
authors.lastname: Messonnier
authors.affiliation: Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, USA; Battelle Memorial Institute, USA. Electronic address: ddz8@cdc.gov.
authors.forename: Inkyu K
authors.initials: IK
authors.lastname: Kim
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007252:Influenza Vaccines / Q000191:economics / Q000627:therapeutic use*; D007251:Influenza, Human / Q000191:economics / Q000517:prevention & control*; D015233:Models, Statistical; D011247:Pregnancy; D019057:Quality-Adjusted Life Years; D014481:United States; D014611:Vaccination / Q000191:economics*
chemical_list: D007252:Influenza Vaccines
keywords: Cost-effectiveness analysis; Pregnancy; Seasonal influenza vaccination