08:04am Sunday 05 April 2020

Ontario’s H1N1 vaccination plan prevented 1 million cases, say U of T researchers

The vaccination campaign launched in response to last year’s H1N1 flu outbreak in Ontario prevented close to one million cases of influenza and constituted a sound investment, according to researchers at the University of Toronto.

The research, published online July 16 in the journal Vaccine, analysed for the first time the cost-effectiveness of Ontario’s mass H1N1 immunization program. The researchers used a disease transmission model to predict what would have happened if no intervention was taken to prevent the spread and impact of the flu and compared this to the reported number of hospitalizations, emergency department visits and deaths.

“At $180 million, it was a costly program, but it was also highly cost effective,” said Beate Sander, who undertook the research as a doctoral student at the University of Toronto Faculty of Medicine’s Department of Health Policy, Management & Evaluation. Sander is also affiliated with the Division of Clinical Decision-Making and Health Care Research at the University Health Network and the Toronto Health Economics and Technology Assessment Collaborative.

In total, Sander’s article, entitled Is A Mass Immunization Program for Pandemic (H1N1) 2009 Good Value for Money? Evidence from the Canadian Experience, estimated that the absence of an H1N1 immunization program would have resulted in 4.1 million cases of symptomatic influenza. Her model also predicted that the program prevented:

• 50 deaths
• 420 hospitalizations
• 28,000 visits to hospital emergency departments
• 100,000 visits to doctors’ offices

The overall health impact of the campaign is measured as quality of life lost, known as quality-adjusted life years (QALYs), a measure of the quality of life lost during the time a person is sick and life lost if dying prematurely. Sander’s analysis showed that the prevention of symptomatic cases and deaths saved 17,000 QALYs. The program also reduced health care cost due to treating fewer cases, thus offsetting 11per cent of the program cost. Most of the cost-saving comes by prevention of non-fatal cases, which nonetheless create a burden on the health care system. This results in an incremental cost-effectiveness ratio of $9,400 per QALY gained, a measure of “value for money”.

“That level of cost per QALY is well-below the World Health Organization’s thresholds for cost-effectiveness. Even in the worst-case scenario the program would still be considered cost-effective under WHO guidelines,” said Sander, currently a health economist with the Ontario Agency for Health Protection and Promotion. “The H1N1 immunization program was not only effective in preventing influenza cases and reducing use of health care resources, it was also highly cost-effective.”

Sander noted that the effectiveness of the program is impacted by timing. “Ontario’s program started just before the outbreak peak. A substantial proportion of the population had already been infected at that time. Nevertheless, Ontario implemented the program in time to accrue significant health benefits at reasonable cost but a further delay would have eroded the program’s cost-effectiveness considerably.”

The full article in Vaccine can be accessed here: http://www.sciencedirect.com/science/journal/0264410X.

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