The cost-effectiveness of influenza vaccination is well established for persons

Question

The cost-effectiveness of influenza vaccination is well established for persons aged 65 years and older. A study considered cost-effectiveness and cost-benefit for healthy adults less than 65 years old. A randomized experiment was run. The treatment group received an influenza vaccination, while the control group received a placebo. Any favorable benefits of influenza vaccination last only for one flu season (a year). We consider the costs and benefits of influenza vaccination for 1,000 adults when per person - The cost of vaccination (including lost work time) is $25. - The cost of influenza illness (including lost work time) is $200. - Influenza vaccination reduces the probability of getting influenza from 0.24 to 0.14. (a) Perform a cost-benefit analysis of influenza vaccination. Does it favor vaccination? (b) What is the cost of influenza vaccination per case of flu avoided? (c)(i) Give a verbal definition of a QALY. (ii) What is the advantage of using QALY’s compared to cost-benefit analysis?

Explanation / Answer

(a) Perform a cost-benefit analysis of influenza vaccination. Does it favor vaccination?

Expected cost (with vaccination) = 25*0.14 = 3.5

Expected cost (without vaccination) = 200*0.24 = 48

Yes it favours vaccination

(c)(i) Give a verbal definition of a QALY.

The quality-adjusted life year or quality-adjusted life-year (QALY) is a generic measure where the benefits, in terms of length of life, are adjusted so that it reflects the quality of life.. The quality-adjusted life-year (QALY) is a measure of the value of health outcomes.

One QALY = 1 year of life in perfect health.

(ii) What is the advantage of using QALY’s compared to cost-benefit analysis?

Cost-benefit analysis requires that benefits be expressed in monetary terms, but QALY permits the use of any commensurate measure of benefits. A more general and sometimes preferable measure is the additional healthy year of life, also known as the quality adjusted life year, or QALY. For example : Lives saved, reduction in illness.

The major criticism of the cost–benefit framework is that it is based on the individual’s willingness to pay for health gain. Since the willingness to pay (WTP) is closely associated with the ability to pay (income or wealth), the valuation based on this will systematically disadvantage those with lower incomes by directly linking health effects to a person's economic resources. In contrast, the QALY and the cost-effectiveness/cost-utility approach allow for social judgement to determine the social WTP for an increase in one QALY.

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