Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2019 The economic and public health impact of influenza vaccinations: contributions of Swiss pharmacies in the 2016/17 and 2017/18 influenza seasons and implications for vaccination policy Brunner, Isabelle ; Schmedders, Karl ; Wolfensberger, Aline ; Schreiber, Peter W ; Kuster, Stefan P Abstract: AIMS OF THE STUDY Healthy adults have had the option to receive prescriptionless vacci- nation against influenza in pharmacies of several Swiss cantons since the 2015/16 influenza season.We aimed to assess in a cost-benefit analysis the resulting net benefits for the Swiss economy andpublic health, and the benefits that could be expected if an extension of the current vaccination recommenda- tions was implemented. METHODS The proportion of influenza vaccines administered in pharmacies was calculated from data provided by pharmacies entering information in phS-net.ch, data from vaccines covered by insurance companies, and vaccine supply data. The economic and public health impact was estimated in a cost-benefit analysis based on published data. RESULTS In the 2016/17 and 2017/18 influenza seasons, 7306 of a total of 1.07 million (0.7%) and 15,617 of a total of 1.15 million(1.4%) influenza vaccine doses, respectively, were administered in pharmacies in Switzerland. The net costsav- ings for the economy due to vaccination in pharmacies in the 2016/17 and 2017/18 seasons were CHF 66,633 and CHF 143,021, respectively. In the 2017/18 season, this resulted –in a net saving per 100,000 inhabitants of CHF 1918, 94.4 cases of illness, 17.6 visits to primary care physicians, 0.328 hospitalisa- tions, 1.1 hospitalisation days, 0.019 deaths prevented, and 0.353 life-years gained. Influenza vaccination proved to be cost-effective provided that a vaccine efficacy of 59% is exceeded. Extrapolations forthe healthy, working-age population revealed that a vaccination coverage rate of 50% and a vaccine efficacy of 70% could save the Swiss economy CHF 18.4 million annually. CONCLUSIONS The service allowing citizens to receive influenza vaccination in Swiss pharmacies is sparsely used. Since influenza vaccination is cost-beneficial as soon as vaccine efficacy surpasses a critical threshold, an extension of thevaccine recommendation for healthy, working-age adults should be considered from an economic point of view. DOI: https://doi.org/10.4414/smw.2019.20161 Posted at the Zurich Open Repository and Archive, University of Zurich ZORA URL: https://doi.org/10.5167/uzh-181666 Journal Article Published Version The following work is licensed under a Creative Commons: Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) License. Originally published at: Brunner, Isabelle; Schmedders, Karl; Wolfensberger, Aline; Schreiber, Peter W; Kuster, Stefan P (2019). The economic and public health impact of influenza vaccinations: contributions of Swiss pharmacies in the 2016/17 and 2017/18 influenza seasons and implications for vaccination policy. Swiss Medical Weekly, 2019(149):w20161. DOI: https://doi.org/10.4414/smw.2019.20161 2 Original article | Published 17 December 2019 | doi:10.4414/smw.2019.20161 Cite this as: Swiss Med Wkly. 2019;149:w20161 The economic and public health impact of influenza vaccinations: contributions of Swiss pharmacies in the 2016/17 and 2017/18 influenza seasons and implications for vaccination policy Brunner Isabellea, Schmedders Karlb, Wolfensberger Alinec, Schreiber Peter W.c, Kuster Stefan P.c a AB Lindenapotheke AG, Unterentfelden, Switzerland b Department of Business Administration, University of Zurich, Switzerland c Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Switzerland Summary used. Since influenza vaccination is cost-beneficial as soon as vaccine efficacy surpasses a critical threshold, AIMS OPF THE STUDY: Healthy adults have had the op- an extension of the vaccine recommendation for healthy, tion to receive prescriptionless vaccination against influen- working-age adults should be considered from an eco- za in pharmacies of several Swiss cantons since the 2015/ nomic point of view. 16 influenza season. We aimed to assess in a cost-benefit analysis the resulting net benefits for the Swiss economy Keywords: influenza, vaccine, pharmacy, cost-benefit, and public health, and the benefits that could be expect- economic impact ed if an extension of the current vaccination recommenda- tions was implemented. Introduction METHODS: The proportion of influenza vaccines adminis- Influenza is a highly contagious disease, with transmission tered in pharmacies was calculated from data provided by rates of up to 25% observed in household studies [1]. It has pharmacies entering information in phS-net.ch, data from been estimated that between 10% and 20% of the popula- vaccines covered by insurance companies, and vaccine tion are infected with influenza each year [2]. Children are supply data. The economic and public health impact was the main reservoir of the disease, but owing to its high in- estimated in a cost-benefit analysis based on published fectivity, adults are also frequently affected. However, in- data. fection rates vary from year to year depending on the vir- ulence of the circulating influenza strains, their antigenic RESULTS: In the 2016/17 and 2017/18 influenza seasons, similarity to circulating viruses from previous years and 7306 of a total of 1.07 million (0.7%) and 15,617 of a total vaccination coverage. Each year between December and of 1.15 million (1.4%) influenza vaccine doses, respective- April, an influenza epidemic with variable magnitude can ly, were administered in pharmacies in Switzerland. The be observed in Switzerland [3]. net cost savings for the economy due to vaccination in pharmacies in the 2016/17 and 2017/18 seasons were Patients with influenza infections may be fully asymp- CHF 66,633 and CHF 143,021, respectively. In the 2017/ tomatic, suffer from mild symptoms of a common cold, 18 season, this resulted –in a net saving per 100,000 in- or may present with severe disease requiring hospitalisa- habitants of CHF 1918, 94.4 cases of illness, 17.6 visits to tion. It is estimated that between 100,000 and more than primary care physicians, 0.328 hospitalisations, 1.1 hos- 300,000 visits to primary care physicians in Switzerland pitalisation days, 0.019 deaths prevented, and 0.353 life- occur every year as a result of influenza infections [4]. In- years gained. Influenza vaccination proved to be cost- fluenza can even be fatal, and most deaths from influenza effective provided that a vaccine efficacy of 59% is occur in elderly people aged 65 and over, who are prone Correspondence: exceeded. Extrapolations for the healthy, working-age to developing severe disease because of comorbidities. In- Dr Stefan P. Kuster, MD, population revealed that a vaccination coverage rate of fluenza is one of the leading causes of death in developed University Hospital Zurich, countries owing to its high infectivity, which results in a Division of Infectious Dis- 50% and a vaccine efficacy of 70% could save the Swiss high yearly incidence. In Switzerland, influenza is estimat- eases and Hospital Epi- economy CHF 18.4 million annually. demiology, Raemistrasse ed to cause 1000 to 5000 hospitalisations and up to 1500 100, CH-8091 Zürich, ste- CONCLUSIONS: The service allowing citizens to receive deaths each year [5]. fan.kuster[at]usz.ch influenza vaccination in Swiss pharmacies is sparsely Swiss Medical Weekly · PDF of the online version · www.smw.ch Page 1 of 10 Published under the copyright license “Attribution – Non-Commercial – No Derivatives 4.0”. No commercial reuse without permission. See http://emh.ch/en/services/permissions.html. Original article Swiss Med Wkly. 2019;149:w20161 The annual economic loss induced by influenza is substan- cost-benefit analysis the resulting net benefits for the Swiss tial. The cost of excess hospitalisations in connection with economy and public health. Our secondary aim was to as- influenza epidemics in the USA was already estimated at sess the benefits that could be expected if an extension of more than USD 1 billion at the beginning of the 1990s vaccination recommendations with regard to working-aged [6]. For Switzerland, models have assumed that the annu- adults was implemented. al direct costs for the Swiss healthcare system amount to around CHF 100 million. If all damages incurred by soci- Materials and methods ety are taken into account, including costs resulting from In order to be able to assess the impact of influenza vacci- sick leave, the annual economic costs increase to almost nations administered in pharmacies in relation to the entire CHF 300 million [7]. number of vaccinations in Switzerland, we collected data Various measures can help prevent transmission and the on the various vaccine delivery channels by accessing dif- development of influenza. Of these, influenza vaccination ferent data sources. These data were then normalised using is considered the most effective preventive measure [8, 9]. population data. Vaccination reduces the risk of influenza and influenza- associated mortality, and is considered the most effective Vaccine supply data way to reduce the severity of the disease and prevent com- The data for influenza vaccine doses supplied to Switzer- plications [10]. Unfortunately, as a result of antigen drift land by manufacturers are collected by the Swiss FOPH