Shah Shetal I, Caprio Martha, Sen Alpana, Hendricks-Munoz Karen
Division of Neonatology, Department of Pediatrics, Stony Brook University School of Medicine, Stony Brook, New York, USA.
J Hosp Med. 2007 May;2(3):158-64. doi: 10.1002/jhm.205.
Trivalent inactivated influenza vaccine has been shown to reduce the number of influenza-related outpatient visits and hospitalizations of children up to 24 months of age. The American Academy of Pediatrics, Centers for Disease Control, and Advisory Committee on Immunization Practices recommend that the influenza vaccine be administered to the first-person contacts of infants less than 6 months of age. However, the economic implications of increasing immunization rates by using the neonatal intensive care unit (NICU) as an arena to capture the parents of these infants has not been fully evaluated. We sought to examine the direct and indirect costs of a program to administer the influenza vaccine to parents in the NICUs of a cohort of tertiary-care units primarily serving a low socioeconomic population.
The probabilities of infants being hospitalized because of infection from contact and of the efficacy of prophylaxis used in the present study were based on published results where possible, with an estimated 10% reduction in hospitalization of patients whose parents had received the vaccine. Variables in the 3- and 4-tiered analyses included chronic lung disease status, estimation if patients had siblings, vaccination status of siblings, seroconversion rate of vaccine, and parental vaccination status. Two thousand six hundred and thirty-two patients were analyzed using 2003 admission data from the New York City Regional Perinatal Center, which encompasses 11 level III NICUs. Hospitalization costs, indirect costs, and outpatient costs were assessed using previously published standard calculations.
On the basis of this computer model, costs were $188 per patient per influenza season, including $6.80 per patient in outpatient costs. Administration of an NICU-based influenza vaccine increased costs to $200 per patient per influenza season, but decreased outpatient costs to $1.40 per patient. For cost savings to equal costs of vaccine administration, there must be either a 20% reduction in influenza hospitalizations of NICU patients or an increase in the sample size per influenza season to 4000 patients.
The cost of administration of the influenza vaccine to parents of NICU patients is higher than the financial burden of influenza in this population as long as the sibling immunization rate remains low. Cost savings do not occur until the treated cohort increases to 4000 patients or the incidence of lung disease in this population increases. Further studies are needed to validate the cost savings of this mode and more accurately assess the financial savings.
三价灭活流感疫苗已被证明可减少24个月及以下儿童与流感相关的门诊就诊次数和住院次数。美国儿科学会、疾病控制中心和免疫实践咨询委员会建议，应为6个月以下婴儿的一级接触者接种流感疫苗。然而，利用新生儿重症监护病房（NICU）作为场所来接触这些婴儿的父母，以提高免疫接种率所产生的经济影响尚未得到充分评估。我们试图研究在一组主要服务于低社会经济人群的三级护理单位的新生儿重症监护病房中，为父母接种流感疫苗项目的直接和间接成本。
本研究中婴儿因接触感染而住院的概率以及预防措施的效果尽可能基于已发表的结果，估计父母接种疫苗的患者住院率降低10%。三层次和四层次分析中的变量包括慢性肺病状况、患者是否有兄弟姐妹的估计、兄弟姐妹的疫苗接种状况、疫苗的血清转化率以及父母的疫苗接种状况。使用纽约市区域围产期中心2003年的入院数据对2632名患者进行了分析，该中心包括11个三级新生儿重症监护病房。住院成本、间接成本和门诊成本使用先前发表的标准计算方法进行评估。
基于该计算机模型，每个流感季节每位患者的成本为188美元，其中门诊成本为每位患者6.80美元。在新生儿重症监护病房接种流感疫苗使每个流感季节每位患者的成本增加到200美元，但门诊成本降至每位患者1.40美元。为使成本节约等于疫苗接种成本，新生儿重症监护病房患者的流感住院率必须降低20%，或者每个流感季节的样本量增加到4000名患者。
只要兄弟姐妹的免疫接种率仍然较低，为新生儿重症监护病房患者的父母接种流感疫苗的成本高于该人群中流感造成的经济负担。在治疗队列增加到4000名患者或该人群中肺病发病率增加之前，不会产生成本节约。需要进一步研究来验证这种模式的成本节约情况，并更准确地评估财务节约情况。
