• Nayer Khazeni, David W Hutton, Alan M Garber, Nathaniel Hupert, and Douglas K Owens.
• Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, 300 Pasteur Drive, H3143, Stanford, CA 94305, USA.
• Ann. Intern. Med. 2009 Dec 15; 151 (12): 829839829-39.

BackgroundDecisions on the timing and extent of vaccination against pandemic (H1N1) 2009 virus are complex.ObjectiveTo estimate the effectiveness and cost-effectiveness of pandemic influenza (H1N1) vaccination under different scenarios in October or November 2009.DesignCompartmental epidemic model in conjunction with a Markov model of disease progression.Data SourcesLiterature and expert opinion.Target PopulationResidents of a major U.S. metropolitan city with a population of 8.3 million.Time HorizonLifetime.PerspectiveSocietal.InterventionsVaccination in mid-October or mid-November 2009.Outcome MeasuresInfections and deaths averted, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness.Results Of Base Case AnalysisAssuming each primary infection causes 1.5 secondary infections, vaccinating 40% of the population in October or November would be cost-saving. Vaccination in October would avert 2051 deaths, gain 69 679 QALYs, and save $469 million compared with no vaccination; vaccination in November would avert 1468 deaths, gain 49 422 QALYs, and save $302 million.Results Of Sensitivity AnalysisVaccination is even more cost-saving if longer incubation periods, lower rates of infectiousness, or increased implementation of nonpharmaceutical interventions delay time to the peak of the pandemic. Vaccination saves fewer lives and is less cost-effective if the epidemic peaks earlier than mid-October.LimitationsThe model assumed homogenous mixing of case-patients and contacts; heterogeneous mixing would result in faster initial spread, followed by slower spread. Additional costs and savings not included in the model would make vaccination more cost-saving.ConclusionEarlier vaccination against pandemic (H1N1) 2009 prevents more deaths and is more cost-saving. Complete population coverage is not necessary to reduce the viral reproductive rate sufficiently to help shorten the pandemic.Primary Funding SourceAgency for Healthcare Research and Quality and National Institute on Drug Abuse.

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