A Computer‐Based, Multivariate, Economic Model of Neonatal‐Intensive‐Care‐Unit‐Based Influenza Vaccine Administration to Parents in a Hospitalist Setting

Background:

Trivalent inactivated influenza (TIV) vaccine has been shown to reduce the number of influenza‐related outpatient visits and hospitalizations in children up to 24 months of age. The American Academy of Pediatrics and Center for Disease Control recommend influenza vaccine administration to first‐person contact of infants less than 6 months of age. However, the economic implications of using the NICU as an arena to capture the parents of these infants ‐ thereby increasing immunization rates – has not been fully evaluated. We sought to examine the direct and indirect costs of a program to administer influenza vaccine to parents in the NICU in a cohort of tertiary care units serving a primarily low socio‐economic population.

Method:

Probabilities of hospitalization and efficacy of prophylaxis were based on published results where possible with an estimated 10% reduction in hospitalization for parents of patients who received vaccine. Variables in the three and four‐tiered analysis included presence of chronic lung disease, estimated presence of siblings, vaccination status of siblings, sero‐conversion rate of vaccine and parental vaccination status. 2632 patients were analyzed using 2003 admission data from the New York City Regional Perinatal Center encompassing 11 Level III NICUs. Hospitalization costs, indirect costs, and outpatient costs were assessed using previously published standard calculations.

Summary of Results:

On the basis of this computer‐model, costs were $188.05 per patient‐per‐influenza‐season, including $6.80 per‐patient in outpatient costs. This increased to 191.30 per patient when parental medical savings were included. Administration of NICU‐based influenza vaccine increased costs to $200.46 per‐patient‐per‐influenza‐season, but decreased outpatient costs to $1.40 per‐patient. The cost rose to $201.14 per patient upon inclusion of parental medical savings. For cost‐savings to equal costs of vaccine administration, either a 20% reduction in hospitalization for infant of vaccinated NICU patients must be achieved or the sample size per influenza season must increase to 3,215 patients.

Statement of Conclusions:

The cost of influenza vaccine administration to NICU parents was higher than the financial burden of influenza in this population. Cost‐savings do not occur until the treated cohort increases to 3,215 patients. Further studies will eliminate the estimates used in the study and more accurately assess financial savings.

Author Disclosure Block:

S. Shah, None; M. Caprio, None; K. Hendricks‐Munoz, None.