Economics of the Timing of Influenza Vaccine

Although the H1N1 influenza virus has garnered most of the media attention, protecting children against standard strains of influenza has generally been shown to be cost effective.  However, the cost effectiveness depends on the timing.  The flu season generally lasts from September to June, but flu generally has the highest incidence in November and December. A paper by Yee et al. (2010) claims that getting all kids immunized could save society between $6.4 million and $9.2 million.  Even third party payers (i.e., insurers) save between $4.1 and $6.1 million due to decrease hospitalization and illness.

The authors find that vaccinating children is cost-effective until December for trivalent inactivated viral vaccine (TIV).  Live attenuated influenza vaccine (LAIV) , however, is only cost effective through November.  But should you believe these recommendations?

The authors estimates of the benefit of moving vaccinations forward seem reliable. When you are vaccinated earlier in the flu season, you will be inoculated against the virus for a longer period of time. This will decrease the risk of hospitalizations, additional physician visits, and absences from work.

What the paper ignores, however, is the supply-side effect of moving all children’s influenza vaccinations to October.  First, inventory costs from storing larger quantities of vaccine will increase.  Lee and co-authors also assume constant returns to scale in the production of vaccine. They assume that producing more vaccine in a shorter amount of time will not affect the cost per vaccine. However, rushing to produce more vaccine likely will increase the price.  The paper says that the H1N1 supplied 70% of the population on time, but this does not necessarily mean that this can be accomplished in a cost-effective manner each year.

Another point to consider is the additional labor cost required to vaccinate children in so short a time period. Medical staffing hours will have to increase in October to meet the seasonal demand and overtime will increase. One solution is to use pharmacies to fill the unmet vaccine demand.

Changing the timing of the vaccine will likely affect its efficacy. Shorter turnaround times may give researchers less time to test a vaccine and thus may make it less effective. On the other hand, if more children are vaccinated in October, the likelihood a vaccine will spoil may decrease.

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