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U-M study: Program to boost elderly flu vaccination could save lives

March 27, 2006

10-year federal flu vaccination program could save more than 6,500 lives

To increase influenza vaccinations rates among the elderly - those ages 65 and over who are at high risk for influenza-related mortality - the federal government could consider borrowing a page from the pharmaceutical companies' prescription drug advertising campaigns.

By using direct-to-consumer advertising, an effective tactic used by pharmaceutical companies to encourage consumers to seek information about new treatments, researchers at the University of Michigan Health System say the federal government could promote flu vaccination to the elderly in a cost-effective manner that would ultimately save lives.

Study results show that if the Department of Health and Human Services were to lead a 10-year flu vaccination program aimed at elderly people with the same intensity as pharmaceutical companies' direct-to-consumer advertising campaigns, it could save more than 6,500 lives at a cost of $37,600 per life-year saved for the duration of the program.

The study, the first to analyze the cost-effectiveness of an intense federal advertising campaign aimed at vaccination, appears in the March 2006 issue of Preventive Medicine.

Annual vaccination is the single greatest defense against the flu, reducing illness, hospitalizations and even death.

Despite being an efficient and cost-effective way to prevent mortality from flu among the elderly, it's still an underutilized tool - with vaccination rates falling more than 25 percentage points below the national goal of 90 percent, says study author Matthew Davis, M.D., M.A.P.P, an assistant professor of pediatrics and internal medicine in the division of General Pediatrics and General Internal Medicine at the U-M Health System, and of public policy at U-M's Gerald R. Ford School of Public Policy.

"Direct-to-consumer advertising for flu vaccine may be an effective method to inform elderly persons unaware or perhaps not yet convinced of potential immunization benefits and motivate them to seek vaccination," says Davis.

"Flu vaccination itself for elderly people is cost-saving to the health care system. By increasing demand through a promotional campaign, we could increase vaccination rates and still have a cost-effective program. Our analysis indicates that is true even if the flu varies in intensity and the vaccine varies in effectiveness from year to year."

While many medical experts are leery of pharmaceutical companies' approach to consumer advertising, few have considered its potential impact for increasing vaccination rates among a targeted group through a program led by the federal government.

So Davis, along with second-year U-M Medical School student Mitesh Patel, analyzed the cost-effectiveness of a hypothetical 10-year federally sponsored flu vaccination promotional program aimed at the elderly. The program was designed to mimic the intensity of a direct-to-consumer advertising campaign, making it stronger and more expensive than a typical government public health promotion program.

They found that such a program would save 6,516 lives, or 69,138 life-years, over the course of 10 years, at a cost of approximately $37,600 per life-year saved.

With a total 10-year cost of $2.23 billion, which includes vaccines and advertising, the program would increase the vaccination rate by 20 percentage points within its first five years, and achieve a 25 percentage point increase at the end of 10 years, attaining the Healthy People 2010 vaccination target of 90 percent.

If the program were less successful in raising vaccination rates, Davis say it would be less cost-effective as a result. For example, if the 10-year program only raised national vaccination rates to 80 percent, the cost-effectiveness would be about $60,000 per life-year saved, he notes.

In all, direct-to-consumer advertising for flu vaccination has the potential to inform and motivate elderly people to seek vaccination, especially since many physicians may fail to recommend influenza vaccinations to the elderly and other high-risk patients, says Davis.

"Some experts are very critical of direct-to-consumer advertising because they believe it causes unnecessary use of expensive medications," says Davis. "However, we can avoid this problem when using direct-to-consumer approaches to promote influenza vaccination among elders. There is no such thing as an unnecessary flu vaccination for a person 65 years or older."

University of Michigan Health System