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By Merritt McKinney
NEW YORK, Mar 20 (Reuters Health) - The elderly and others at high risk of complications from the flu, such as pregnant women, are encouraged to get flu shots each year, but a Minnesota researcher reports that immunizing all healthy working adults makes economic sense.
Healthy working adults have a low risk of developing serious flu-related complications, but widespread vaccination may result in savings by reducing physician visits and missed workdays, according to a report in the March 12th issue of the Archives of Internal Medicine.
With most vaccination drives concentrated on the elderly and other high-risk groups, fewer than 25% of healthy working adults aged 18 to 64 get a flu shot each year. The evidence on whether vaccinating most healthy adults is cost-effective--or even a money saver--has been mixed. One recent study of workers at the Ford Motor Company showed giving all workers the flu shot cost the company more than $65 per worker.
To further investigate whether widespread vaccination is worth the extra money, Dr. Kristin L. Nichol from the University of Minnesota in Minneapolis constructed a model that weighed the costs of vaccination against the costs prevented by immunization.
Besides the costs of giving flu shots, other direct and indirect costs of vaccination include the time spent away from work to get vaccinated, as well as the costs of treating side effects that the vaccine may cause.
Based on Nichol's estimates, about 12 missed workdays and 2.5 trips to the doctor's office would be prevented for every 100 healthy working people who received a flu shot. This translated to an average savings of nearly $14 for every person vaccinated.
However, Nichol notes, vaccination could end up costing more than it saves, particularly during flu seasons in which the vaccine does not match the most common type of flu virus.
Still, based on her analysis, Nichol concludes that vaccinating healthy working adults should save money about 95% of the time.
"The results of this cost-benefit analysis suggest that substantial health and economic benefits might be realized from vaccinating all working adults against influenza, especially when immunization occurs at the work site or other efficient and low-cost settings," Nichol concludes.
"Influenza is not just a nuisance illness, even for healthy working adults," Nichol told Reuters Health. "It can cause substantial human misery, and life and work disruption. Prevention of influenza through vaccination can provide health and economic benefits to this group that is not traditionally given a high priority for vaccination."
Calculating the economic benefits of flu vaccination is difficult, Dr. Carolyn Buxton Bridges, of the Centers for Disease Control and Prevention in Atlanta, Georgia, told Reuters Health in an interview.
Bridges noted that even though the flu vaccine brings health benefits in most years, any cost savings provided by vaccinating healthy adults depends on many different factors. How well the vaccine matches the flu type circulating in a particular season, as well as the severity of flu outbreaks, can affect the cost-effectiveness of vaccinating healthy adults, she said.
"In some years it's going to provide cost savings," according to Bridges, who was not involved in the study. But people should not initiate vaccination programs for healthy adults "with the idea that they are going to save money every year," she said.
"That may not be the best motivator for vaccinating adults," Bridges said. She noted that vaccination efforts remain focused on people at high risk for complications.
Nichol has received research funding from companies that make flu vaccines.
SOURCE: Archives of Internal Medicine 2001;161:749-759.
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