هزینه های اقتصادی ناشی آنفلوانزا-بازگو کننده غیبت از کار

Background: Influenza vaccinations are currently advocated only for individuals over age 50. However, vaccination of all working-age people may be warranted based on reduced absenteeism from work. Objective: This study aims to quantify the association between lost workdays and influenza, controlling for other factors. A secondary aim of the study is to assess the net benefit of expanded vaccination in a workplace setting. Research design: Multivariate regression analyses of the 1996 Medical Expenditure Panel Survey Household Component are used to estimate the number of workdays missed because of influenza-like illness (ILI) when controlling for other health, demographic, and employment factors. Mean productivity costs are measured in terms of absences from work and valued in dollar terms. The net benefit of influenza vaccination is estimated using a simple decision analysis. Subjects and measures: Health, demographic, and employment data for employed individuals between the ages of 22 and 64 years are analyzed. Results: The average number of workdays missed due to ILI was 1.30 days, and the average work loss was valued at $137 per person. The vaccine strategy was not preferred in the baseline analysis; however, this result was sensitive to assumptions regarding the incidence of influenza, the cost of delivering the vaccine, and the productivity impact of worker absenteeism. Moreover, nonproductivity benefits of vaccination were omitted. Conclusions: The economic attractiveness of expanded investment in influenza vaccination hinges on employerand population-specific assumptions. Our analysis provides a simple framework within which competing considerations of disease epidemiology, worker productivity, and economic cost may be weighed. Keywords: absenteeism, influenza, MEPS, productivity costs.

Influenza epidemics occur nearly every year from the late fall through the early spring. In the United States, the disease causes an average of approximately 110,000 hospitalizations and 20,000 deaths per year and imposes a significant economic burden [1]. Treatment and hospitalization occur frequently in high-risk populations, including people 65 years or older and those of any age with underlying chronic respiratory, cardiovascular, metabolic, or renal diseases [2]. Even for healthy adults, the typical symptoms of influenza can restrict daily activities. Kavet [3], in 1977, estimated that the costs of work loss due to influenza ranged from $0.5 to $2.0 billion, using epidemic models for which the incidence of influenza was assumed to range from 11% to 26%. The cost-effectiveness of influenza vaccination for elderly and other high-risk populations is well established [4]. Indeed, the Advisory Committee on Immunization Practices has recommended annual vaccination against influenza for individuals older than 50 years and all adults and children with chronic medical conditions [1]. However, whether vaccination is cost-beneficial for the working-age population has not been determined. While recent studies show that vaccination programs reduce health costs in large corporate settings [5–9], the generalizability of these findings to all working-age individuals is not clear. Nichol [10] conducted a cost-benefit analysis of vaccination using a Monte Carlo decision model to adjust for demographic characteristics, year-to-year variability, and vaccine efficacy rates. However, this analysis still relied upon the corporate study results cited above for its base-case estimates of worker absenteeism (base case: 2 days; range: 0.75–4 days). The present study is motivated by the hypothesis that there are potential societal gains to be enjoyed from greater investment in the vaccination of employed, working-age individuals. To that end, we aim to estimate the economic costs of influenzarelated absenteeism from work using nationally representative samples and to compare these to the estimated costs of increased vaccination. Such information could help to support revision of current guidelines to include working-age individuals. It could also help both employers and employees to identify the degree to which they would benefit from worker vaccination and the extent to which they might be willing to bear a share of any new vaccination program implementation costs.

The economic attractiveness of investing in influenza vaccine depends greatly upon the costs of vaccine, the costs of lost time, and the incidence of influenza in a specific population. The simple decision rule we have developed could be useful to decision makers in weighing these competing considerations and tailoring the vaccine decision to the characteristics of specific employers and at-risk employee populations. Portions of this paper are based on research conducted by M.A. for his Master of Public Health thesis at the Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, CT.