Our study suggests that employer-supported workplace-based influenza vaccination can be relatively inexpensive (<$35 per vaccinated employee) or cost saving for employers, even when ignoring the benefits of vaccination to unvaccinated employees. These findings hold across a wide variety of occupational groups. For many occupational groups, vaccination may even be cost saving; employers could gain money by implementing such programs. Factoring in the potential benefits of vaccination for the unvaccinated only improves the cost savings of vaccination programs. Certain employers will realize a greater return on influenza vaccination, especially those investing heavily in the productivity of their employees.
Improving access, by means of an employer sponsored in-house program or paid time to seek vaccination, may also serve as an incentive to increase vaccine uptake; employees may be reluctant to pay out-of-pocket for the influenza vaccine or take time off from work for immunization if it will affect their pay or accrued personal time. Future studies are needed to further delineate the impact of incentives on vaccine uptake among the general non-healthcare working population.
Because adults spend a large amount of time at their place of work, an employer's decision to implement a workplace-based influenza vaccination program can have broad impact on the health of individuals, a workplace and the total population. The health of employees is central to workplace productivity, and subsequently, local, national and global economies and infrastructure. The CDC and OSHA have recommended that businesses and employers develop preparedness plans for seasonal and pandemic influenza that prioritize employee vaccination.[9
] Employee vaccination programs are an example of engineering work practice controls — enduring and effective interventions that do not rely on individual behavior change. Employers who subsidize workplace vaccination programs stand to see significant a significant return on their investment, particularly during a severe influenza season or pandemic when employee productivity may be interrupted by influenza-related absenteeism.
Employers collectively bearing the costs of influenza immunization could alleviate some of the burden on the already strained public health and medical systems. Studies have implied that many businesses are not currently implementing influenza vaccination programs, even though recent concerns of a pandemic have motivated some businesses to develop pandemic influenza preparedness plans.[14
] One potential problem is that existing studies have been from specific workplaces at specific locations. For example, a study of a Malaysian petrochemical plant demonstrated that workplace vaccination clearly decreased influenza-like illness rates and absenteeism.[26
] A cost-benefit analysis of a workplace vaccination program at a Brazilian pharma-chemical company yielded a net benefit of $121,441 or $35.45 per vaccinated employee in 1997 U.S. dollars.[25
] A clinical trial at six North Carolina textile plants showed that a vaccination program saved $22.36 per lost workday and $2.58 per dollar invested.[18
] A prospective observational study at a Columbian bank estimated an employer savings of $6.40 to $25.80 US per vaccinated employee. A vaccine campaign at First Data Resources Limited in Basildon, Essex UK, resulted in substantial decreases in influenza-like illness.[40
] It is not clear, however, if employers view results from a limited number of workplaces as being applicable to their unique setting.
Constructing economic models from the employer's perspective can help employers understand the value of vaccination. Many existing economic models that take the perspective of society and third party payors may be helpful in making policy and insurance coverage and reimbursement decisions but may not motivate individual employers. Although cost-effectiveness models can provide important information to policy-makers, employers may not be interested in translating these to their individual situations. The focus of most individual employers is to maintain the profitability of their businesses, especially in difficult economic climates. While demonstrating the worth of a public health or medical intervention to society may appeal to the altruism of some employers, demonstrating the potential positive impact of an intervention on a business's profit and loss statements may be an easier argument to make.
Rather than make decisions, computational models provide information to help employers make decisions with respect to their own set of unique circumstances. In the end, people—not computational models—make decisions, but models can help elucidate relationships, factors, and effects that are not readily apparent and provide rough benchmarks. Employers can then adapt model findings accordingly and implement appropriately tailored solutions.
All computational simulation models simplify real life situations and cannot completely represent every possible event and outcome that may result from vaccination or influenza. Data inputs for our model came from different studies with varying sample sizes and quality of design. Our model used distributions of parameters and may not fully reflect the socio-demographic, operational, and financial heterogeneity of an individual workplace.
By design, our model remained conservative about the benefits of employer-sponsored vaccination. It did not include a number of additional costs that could arise from influenza infection. First, we assumed employees to be otherwise healthy individuals who did not suffer extended work absences (more than one work week) or substantial absenteeism due to hospitalization for influenza; additionally, the productivity loss attributable to presenteeism (in the case of an ill employee who continues to work), including any time lost for an outpatient medical visit, was not accounted for. Second, our model did not address how the appearance of influenza, especially pandemic influenza, in a workplace may affect the productivity or attendance of healthy individuals and fears of infection may keep employees from showing up to work or impact productivity.[41
] Third, the model assumed that employers would not bear any costs of treating influenza and its symptoms (e.g., over-the-counter medications, tissues, and insurance premiums) when employers may bear these costs. This is especially true of employers who contract with occupational physicians or maintain workplace health clinics.[43
] To remain conservative about the benefits of vaccination, we only accounted for cases that could be generated directly by an employee becoming infected. In actuality, an infected employee could generate a cascade of cases (i.e., the employees whom he or she infected could in turn infect others). However, the number of resulting cases could vary substantially by different mixing patterns and vaccination coverage (employees could have been vaccinated outside the workplace). Preventing this cascade of cases would only add to the value of employee vaccination.
Not all workplaces will have the resources (e.g. computer equipment, meeting space, language translation services and funding) to implement more complex education programs utilizing computer- or internet-based content. Therefore, we chose freely available (on-line) content for our educational materials. However, individual employers may elect to incorporate different, more expensive educational programs, including print materials or sessions with health educators. When deciding whether to sponsor a workplace vaccination campaign, employers should review their individual company's financial circumstances, and how the amount of funding available compares to the cost of implementing a workplace vaccination program. The cost of vaccine and administration/disposal supplies, and healthcare worker wages may vary depending on the vaccine presentation (e.g., TIV and/or LAIV) offered and affect the overall cost of a program.
Salaries are an imperfect proxy for employee productivity; pay is not necessarily commensurate with an employee's worth to a firm and may underestimate the full value of an employee's time to the employer. Certain key personnel, especially those with supervisory roles or pivotal technical skills, may influence the productivity of many other employees. Employees that interface regularly with clients or other outside individuals (e.g., teachers with students, health care workers with patients, salespeople with customers, and restaurant personnel with diners) may have a great impact on the firm's return business and revenues. Model input parameters, such as attack rate and R, are not available for all 22 of the major occupational groups included in our analyses, which may limit our ability to fully capture workplace dynamics. The results of sensitivity analyses, including those for attack rate and R across a range of occupational groups, may be referenced as benchmarks for settings in which these parameters are known.
Implementing workplace seasonal or pandemic influenza vaccination appears to be relatively inexpensive and potentially cost-saving for a wide variety of employers in diverse industries. Because employees comprise a large proportion of the overall population and spend a substantial amount of time at work, employer decisions may be important for overall influenza control. While demonstrating the worth of an influenza vaccination to society may appeal to the altruism of some employers, demonstrating the potential positive impact of vaccination on a business's profit and loss statements provides relevance to individual employers who seek to maintain their firm's profitability throughout the influenza season. Individual employers could compare their prevailing conditions with the benchmarks in our model to help determine their optimal local vaccination strategies.