Cost effectiveness of an inpatient influenza immunization assessment and delivery program for children with asthma.

BACKGROUND Influenza is common in children. Children with asthma are underimmunized. The Centers for Disease Control recommends immunization in an acute-care hospital setting. OBJECTIVE The purpose of this study was to determine the potential clinical benefit and cost savings of delivering influenza vaccination to hospitalized children with asthma. DESIGN The study was designed as a decision and cost-effectiveness analyses. A decision tree was constructed to represent an intervention to assess and deliver influenza vaccinations to hospitalized pediatric patients with asthma. A literature survey provided estimates for the decision tree assumptions. In the decision analysis, various rates of screening for influenza vaccine status were investigated to determine the effects on final up-to-date (UTD) status in a hypothetical cohort. The cost-effectiveness analysis was used to determine potential cost savings resulting from the modeled increase in UTD status. MEASUREMENTS The percentage of children ultimately becoming UTD, direct and indirect costs, and cost savings of the intervention were measured. RESULTS With existing data showing that only 29% of asthmatics receive the influenza vaccine in a given year, our decision analysis demonstrated that even modest increases in the screening rate for influenza vaccine status among hospitalized patients with asthma can result in clinically significant increases in UTD status. For example, screening just 20% of those with asthma who are hospitalized would result in 35% ultimately being UTD for that influenza season; and 100% screening would result in 59% being UTD. The cost savings for this intervention would be $5.45/child assessed and $9.19/child vaccinated. Sensitivity analysis demonstrated the results to be robust and generalizable. CONCLUSIONS An intervention to improve the assessment and delivery of influenza vaccination to hospitalized pediatric asthmatics would improve clinical outcomes and result in cost savings.