Is Adult Immunisation Cost Effective?

To better understand the fiscal consequences of adult vaccination, a case study was conducted to evaluate comprehensive adult vaccination for those over the age of 50 years in the Netherlands. The Netherlands was selected due to the availability of data on pu­blic expenditure and meaningful data on the clinical benefits of vaccination.

To assess the fiscal impact of health, this study followed a “lifetime modelling” approach, which considered how investments influence both transfers from government (e.g. social services, pensions, healthcare) compared with ongoing tax transfers to government (e.g. income tax, value added tax, social insurance).

The analysis takes into account the gross tax receipts to the government for adults vaccinated against the seven main infectious diseases (seasonal influenza, pneumococcal diseases, pertussis, herpes zoster, diphtheria and tetanus) compared with those non-vac­cinated. Estimates for lifetime productivity and labour force participation are derived from projected incidence rates for each of the diseases in vaccinated and non-vaccinated cohorts. Linked to vaccine invest­ment costs, the analysis projects future tax revenue associated with the resulting changes to morbidity and mortality rates. This entails accounting for future income tax payments (over their remaining lifetime), based on: retirement projected to the age of 67, life­time value added tax contributions, and social insu­rance contributions. These three contributions reflect the financial value to the Dutch government from the changes in tax revenue, linked to infection rates.

The budget needed for vaccinating a cohort of individuals aged 50 years in 2012 was estimated to be €136 million, which includes annual costs for influenza vaccination for the remainder of life. These costs were based on historical evidence of influenza vaccination coverage rates of 77%, and were extended to all vaccines. In return, the adult immunisation programme for the seven main infectious diseases in the Netherlands was projected to:

  • Prevent 34,528 infectious disease cases over the remaining life span.
  • Prevent roughly 5,782 premature deaths from infections.
  • Reduce the number of lost work days by 127,480 days with an estimate of 29 fewer disability cases over the remaining number working years for those vaccinated at 50-years of age.
  • Generate health cost savings reaching €6.6 million and an additional €4.2 million in social insurance savings paid towards disability and sick day pay­ments to workers.
  • Generate future lifetime tax contributions from implementing adult vaccination, which would result in a revenue gain of €537 million over the remaining life years of the cohort.

The project revenue gains yielded a benefit-cost ratio of 4.02, suggesting that for every €1 invested in adult vaccination commencing at the age of 50 years would yield €4.02 over the remaining lifetime of the cohort. The economic consequences of reducing the number of infectious cases in adults was projected to yield a range of benefits for government including medical cost savings, reduced disability costs and increased tax revenue linked to labour force activity. These findings are consistent with the SHARE study (2005) which demonstrated that older populations, despite diminishing earnings, have a significant resi­dual societal and fiscal value (i.e. disposable income and consumption), which translates into tax revenue for the government.

For more information, see: Adult vaccination – a key component of healthy ageing