Scenarios on costs and savings of influenza treatment and prevention for Dutch healthy working adults.

OBJECTIVE: To assess the economic implications of strategies for influenza control among healthy working adults in The Netherlands. METHODS: The economic evaluation was based on a pharmaco-economic model from the societal perspective. This model involves the direct and indirect costs of vaccination or treatment and the direct and indirect savings (averted costs) due to the control strategy. Control strategies comprised treatment with oseltamivir and prevention with the influenza vaccine. Clinical and economic parameter estimates were derived from published literature, databases and expert opinions. Several scenarios for age-groups and employment contracts (full-time versus not) were elaborated in combination with Monte Carlo simulation for probabilistic sensitivity analysis. RESULTS: Consistently, net cost savings are estimated over the range of age groups and scenarios considered. Net savings are smallest for half-time workers. Incremental analysis indicates that on average prevention renders higher cost savings than treatment. CONCLUSION: We found a consistent picture of net cost savings for prevention through vaccination and treatment with oseltamivir of influenza in healthy working adults in The Netherlands.

Pharmacoeconomics of influenza vaccination for healthy working adults: reviewing the available evidence.

A favourable pharmacoeconomic profile has been well established for influenza vaccination in the elderly. For employers relevant benefits seem to exist for vaccinating healthy working adults to avert absenteeism and related production losses. From a pharmacoeconomic point of view it is relevant to consider whether societal benefits of vaccination for healthy working adults is worthwhile given the costs of vaccination for the community. We searched Medline and Embase using the key words influenza (vaccination) in combination with cost, cost-benefit, cost-effectiveness, efficiency, economic evaluation, health-policy and pharmacoeconomics. From this primary search, we selected 11 studies concerned with the group of healthy working adults. We reviewed these studies according to several criteria: benefit-to-cost (B/C) ratio;vaccine effectiveness, influenza incidence, number of days of work absence due to illness; and relative cost of the vaccine. Three studies on vaccinating healthy working adults found costs exceeding the benefits (B/C-ratio <1). The remaining eight pharmacoeconomic studies found a B/C-ratio of almost two or more. Cost savings are strongly related to the inclusion of indirect benefits related to averted production losses. After exclusion of indirect costs and benefits of production gains/losses, only one of the eight studies remains cost saving. Considering the available pharmacoeconomic evidence, vaccination of healthy working adults in Western countries may be an intervention with favourable cost-effectiveness and cost-saving potentials if indirect benefits of averted production losses are included. Excluding indirect benefits and costs of production losses/gains, cost-saving potentials are limited. Recent international guidelines for pharmacoeconomic research advise the inclusion of production gains and losses in the preferred societal perspective. Hence, on the basis of the available evidence, influenza vaccination of healthy working adults may be recommended from pharmacoeconomic point of view. Pharmacoeconomics do, however, present only one argument for consideration aside from ethical issues, budgetary limits and psychosocial aspects.