Compared to the number of published studies from the societal and third party payor perspectives, relatively few economic studies have looked at medical interventions from the patient perspective. The vast majority of health economic studies focus on the societal perspective, summing costs across all key stakeholders, or have evaluated whether a large policy-making entity (e.g., government) should make an intervention available or a third party payor (e.g., Medicare or commercial insurance) should cover an intervention. However, when the objective is to increase historically low influenza vaccination rates, accounting for only these two perspectives is myopic and may fail to account for key driving forces or stakeholders. Cost is certainly not the only (or even the primary) factor in a patient’s decision to get vaccinated, but its role is salient. As direct-to-consumer marketing grows more pervasive in health care, the patient economic perspective may be increasing in importance.
A trend over the past two decades has been casting patients as “consumers,” who must choose among goods or interventions offered by traditional and non-traditional health care providers.[34
] Commercials and advertisements tout the “value” of health care goods and services. While this value is sometimes quantified in terms of clinical efficacy, it is often not quantified monetarily. In many other situations where consumers have a choice (e.g., purchasing automobiles, food, or clothing), understanding the economic value of a good or service from the consumer’s perspective can help both the consumers and providers of the good or service. Consumers may realize that a good is either more or less valuable than anticipated, which may in turn affect their decision-making (e.g., is it worthwhile to miss work to get vaccinated). Providers may be able to tailor the good or service to assist the consumer (e.g., making it more convenient for patients to get vaccinated or adjusting the price of the vaccine).
Although economic indicators and models cannot fully capture all the advantages and disadvantages of a medical intervention, they can offer important benchmarks, perspectives, and insights. In our model, the strongest drivers of the vaccine’s economic value were the clinical attack rate followed by vaccination cost and the time required (i.e. lost productivity) by the individual to get vaccinated. This suggests that in a seasonal or a relatively mild pandemic scenario such as the 2009 H1N1 pandemic, making influenza vaccination less costly and more convenient may be an important priority and prerequisite for improved vaccination coverage.[4
] For example, providing vaccination at locations the patient already frequents (e.g., work, churches, retail shops and clinics, concerts, athletic events, and other public gatherings) may be a useful cost-saving measure for individuals. Alternatively, in more severe epidemics, making a special trip and queuing for vaccination may be relatively less costly for an individual.
The relative parity in cost of vaccination observed between uninsured and insured individuals is informative as well. Finding a significant difference between the two would be expected based on reports that insurance status often dictates the decision to get vaccinated, and also would suggest that more tailored approaches to promote vaccination in each group may be needed.[4
] Instead, the two groups seem to be facing similar costs for vaccination, i.e., lack of insurance coverage may not actually be a barrier for vaccination.
All computer models make simplifying assumptions and cannot represent all possible outcomes that may arise from influenza vaccination or disease. Additionally, they cannot account for the vast diversity in the socio-demographic and health characteristics of the adult population. Our model only considered the healthy adult population which comprises the majority of the population. High-risk individuals (e.g., those with major co-morbidities such as diabetes, pregnant women, or health care workers) may either have higher risk for influenza-associated morbidity and, therefore, could reap more benefits (i.e., greater cost-savings) from vaccination or could have additional reasons for being immunized (e.g., protecting neonates or patients). Future studies may focus on different categories of high-risk individuals. Although all data came from referenced sources identified from an extensive review of the literature and widely-used databases, the choice of probability distributions could bias the results. Costs drew from gamma distributions, frequently utilized for health care related costs that tend to cluster in the lower end of the distribution and have relatively fewer higher costs trail off into the upper tail. Probability parameters drew from beta distributions, frequently used to represent continuous variables that have values between 0 and 1. Lastly, parameters with relatively sparse observations drew from triangular distributions, built from a minimum, maximum, and likeliest value.[38
] Moreover, it is difficult to quantify (both monetarily and in terms of health benefits) all facets of vaccine value, such as convenience, patient preference (for either injection or nasal spray, where indicated) and comfort, and the relative worth of LAIV and TIV for all scenarios. The decision to get the influenza vaccine and the type of vaccine administered should be determined on a case-by-case basis.
4.2 Conclusions and Future Directions
Understanding the cost-benefit of vaccination from the patient perspective can provide interesting insights for vaccination policy. While cost is certainly not the only driving factor in a patient’s decision to get vaccinated, studies have suggested that a patient’s perceived cost-benefit of a medical intervention could affect his or her utilization of the intervention. Aside from vaccine cost and attack rate, one of the biggest drivers of vaccination costs was a patient’s time required for vaccination, so decision makers may want to focus on ways to reduce this time, such as bringing vaccination to individuals (e.g., at work, churches, or other normally frequented locations). Ideally, reducing the time demand and cost of immunization for patients will help improve influenza vaccine coverage.