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Table 2 Cost-effectiveness analysis of school-located seasonal influenza vaccination (SLV-I) during the 2009–2010 season (Year 1)a and the 2010–2011 season (Year 2) (all 2010 US $)b; Unit is incremental cost-effectiveness ratio (ICER)c [$-per-incremental-student-vaccinated in the school-located seasonal influenza vaccination (SLV-I), compared to control schools]

From: Cost effectiveness analysis of Year 2 of an elementary school-located influenza vaccination program–Results from a randomized controlled trial

  Year 1a Year 2
(A) School coste $9.92 $8.25
($6.41, $14.75)k ($5.33, $12.26)k
(B) Project coordination costf $25.35 $32.33
($16.37, $37.65)k ($20.87, $48.02)k
(C) Vendor cost from the societal perspective (=C1+ C2) $33.99 $28.74
($26.23, $44.76)k ($22.83, $36.84)k
 (C1) Vaccine administrationg $21.91 $16.68
($14.15, $32.68)k ($10.77, $24.78)k
 (C2) vaccine purchase from the societal perspective (VFC dose = $10.76 (Year 1) $10.94 (Year 2)h $12.08 $12.06
 (C3) Vaccine purchase from the alternative perspective of school districts, health departments, and insurers (VFC dose = $0)h $6.48 $6.37
(D) Averted parents’ costs (i.e., to visit medical practices for a child’s influenza vaccination)i $35.66 $35.66
Subtotal Net Cost 1: (A + B)-(D) $1.15m $6.64m
(−$7.46, $10.31)l (−$3.93, $17.93)
Subtotal Program Cost 2: (A + B + C1) $59.73 $59.88
($48.26, $71.73)l ($47.69, $72.74)l
Subtotal Program Cost 3: (A + B + C1 + C3) $66.19 $66.06
($54.94, $78.13)l ($53.94, $78.69)l
Total Program Cost 1 from the societal perspective: (A + B + C) $71.78 $71.74
($60.32, $83.77)l ($59.75, $84.47)l
Total Net Cost 2 to compare with influenza vaccination in private pediatric practices: (A + B + C1)-(D) $23.96n $24.07n
($12.79, $35.99)l ($12.08, $37.00)l
Total Net Cost 3 from the societal perspective accounting for averted parents’ costs: (A + B + C)-(D) $36.16 $36.01
($24.82, $48.13)l ($23.93, $48.76)l
  1. a: Only first clinics at each SLV-I school (not including the vaccinated children at the second vaccination clinics (2.0 % among all students) in Year 1)
  2. b: All cost estimates were adjusted to 2010 U.S. dollar values with the consumer price index when needed [31]
  3. c: Incremental cost-effectiveness ratio (ICER) was estimated by dividing the incremental cost (i.e., the difference in cost of vaccination in intervention schools minus the cost of vaccination in control schools (i.e., a reference group)) by the incremental effectiveness (i.e., the number of additionally vaccinated students in intervention schools compared to control schools). In control schools, some students were vaccinated outside schools (e.g., medical practices), as summarized in Table 1
  4. d: The values within the parentheses in the rows for COMPONENT COSTS indicate the triangular distributions defined by the modal value, (minimum value and maximum value). The modal value was assumed to be equal to the overall mean of the SLV-I schools. The minimum and the maximum values were determined among the eleven mean cost estimates from eleven SLV-I schools, following our Year 1 analysis [28]
  5. e: Composed of material cost and labor cost. Material cost includes information distribution (to parents) costs such as paper, mailing, and phone. Labor cost was calculated through “the time spent for the project by school staffs” multiplied by “category-specific hourly wage (national average)” as of May 2009 [58] and May 2010 [32] for Year 1 and Year 2, respectively
  6. f: Time cost for collection of consent forms, and meeting with school staffs, and vendors. Evaluation research cost was excluded
  7. g: Composed of the vendor’s labor and material costs, including broad items such as the refrigerator for vaccines and supplies
  8. h: 52 % of the administered doses that were provided by Vaccine-for-children (VFC) for free. From a societal perspective, we assigned $10.76 (Year 1) and $10.94 (Year 2) per dose as the vaccine purchase cost, which is the weighted average prices of TIV (80 % of doses administered in this demonstration) and LAIV (20 %) listed in the CDC website as of May 2009 [34] and May 2010 [33] for Year 1 and Year 2, respectively
  9. i: This (D) averted parents’ costs indicate the costs to visit medical practices for a child’s influenza vaccination, consisting of parents’ time cost [3537] and transportation cost [38]. These costs do not include any medical expenditure, either paid by parent or incurred at medical practices
  10. j: The values within the parentheses in the rows for subtotal costs and total costs indicate the mean and 95 % confidence interval of Monte Carlo Simulation results (10,000 iterations) using the distributions defined in the rows for component costs. The 95 % confidence interval was assumed to be equal to the range of the 2.5th and 97.5th quantiles of the iterations
  11. k: The minimum and the maximum values, for the components (A) and (C1), were determined among the eleven data points from the individual SLV-I schools. Regarding the component (B), we used 4 data points derived from 4 groups of schools based on the geographic area (urban/rural) and the intensity of an intervention outreach activity (high/low)
  12. l: 95 % confidence interval values (under a Monte Carlo Simulation) are in parentheses
  13. m: Below the lower limit of the cost range ($11.59, $17.38) [per child vaccinated] in the reminder program (using letters and/or automated telephone message) estimated by Lieu et al. [59]
  14. n: Falls between the 25th percentile ($13.88) and the median/mean ($22.17/$39.54) cost [per dose] for providing influenza vaccination in private pediatric practices estimated by Yoo et al. [28, 30]