• Laura J Anderson, Paul Shekelle, Emmett Keeler, Lori Uscher-Pines, Roberta Shanman, Sally Morton, Gursel Aliyev, and Teryl K Nuckols.
• Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; Department of Epidemiology, UCLA Jonathan and Karin Fielding School of Public Health, University of California-Los Angeles, Los Angeles, California. Electronic address: laura.anderson@cshs.org.
• Am J Prev Med. 2018 Feb 1; 54 (2): 299-315.

ContextInfluenza vaccination rates remain below Healthy People 2020 goals. This project sought to systematically review economic evaluations of healthcare-based quality improvement interventions for improving influenza vaccination uptake among general populations and healthcare workers.Evidence AcquisitionThe databases MEDLINE, Econlit, Centre for Reviews & Dissemination, Greylit, and Worldcat were searched in July 2016 for papers published from January 2004 to July 2016. Eligible studies evaluated efforts by bodies within the healthcare system to encourage influenza vaccination by means of an organizational or structural change. For each study, program costs per enrollee and per additional enrollee vaccinated were derived (excluding vaccine costs, standardized to 2017 U.S. dollars). Complete economic evaluations were examined when available.Evidence SynthesisOf 2,350 records, 18 articles were eligible and described 29 unique interventions. Most interventions improved vaccine uptake. Among 23 interventions in general populations, the median program cost was $3.27 (interquartile range, $0.82-$11.53) per enrollee and $50.78 (interquartile range, $27.85-$124.84) per additional enrollee vaccinated. Among ten complete economic evaluations in general populations, three studies reported net cost savings, four reported costs <$50,000 per quality-adjusted life year, and three reported costs <$60,000 per life saved. Among six interventions in healthcare workers, the median program cost was $8.09 (interquartile range, $5.03-$10.31) per worker enrolled and $125.24 (interquartile range, $96.06-$171.38) per additional worker vaccinated (there were no complete economic analyses).ConclusionsQuality improvement interventions for influenza vaccination involve per-enrollee costs that are similar to the cost of the vaccine itself ($11.78-$36.08/dose). Based on limited available evidence in general populations, quality improvement interventions may be cost saving to cost effective for the health system.Copyright © 2017 American Journal of Preventive Medicine. All rights reserved.

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