Ontario's universal influenza program

A universal program to provide free influenza vaccination to everyone in Ontario, Canada is economically attractive compared to vaccination programs in other Canadian provinces targeting people at high risk of influenza, according to an analysis published in PLoS Medicine this week.

Beate Sander of the University of Toronto and colleagues evaluated the health outcomes and health care costs of Ontario's program which since 2000 has offered everyone over six months of age a free influenza vaccination. Their appraisal follows a 2008 study also published in PLoS Medicine showing that after the introduction of the universal program in Ontario vaccination rates increased, deaths from influenza decreased and influenza-related use of health care facilities decreased in comparison with the provinces with targeted programs. Most Canadian provinces target free vaccination programs only at people aged 65 years or older, those with chronic medical conditions or health care workers - all groups that are at high risk of influenza complications.

The researchers compared vaccine uptake, physician visits, emergency department visits, hospitalizations and deaths from influenza in Ontario and nine other Canadian provinces between 1997 and 2004. Ontario's universal program cost about twice as much as the targeted vaccination program, but the researchers estimate that it reduced the number of influenza cases by two thirds and the number of influenza deaths by more than a quarter. The researchers calculated that the additional expenditure required to generate a year of perfect health - expressed as cost per quality-adjusted-life-year (QALY) - in Ontario 's universal program was approximately Can$11,000 per QALY gained, a figure that would be considered cost-effective in high-income countries such as Canada.

The researchers conclude that Ontario's universal program is economically attractive - reducing the number of influenza cases and deaths and reducing health resources used. They acknowledge that province-specific epidemiological and health care factors may have influenced the size of this effect. But given the findings, the researchers suggest that universal vaccination programs may be an appealing intervention in other Canadian provinces and in high-income jurisdictions with influenza transmission rates and health care costs similar to those in Ontario.