School-Based Influenza Vaccination: Health and Economic Impact of Maine's 2009 Influenza Vaccination Program

Health Serv Res. 2017 Dec;52 Suppl 2(Suppl 2):2307-2330. doi: 10.1111/1475-6773.12786.


Objective: To estimate the societal economic and health impacts of Maine's school-based influenza vaccination (SIV) program during the 2009 A(H1N1) influenza pandemic.

Data sources: Primary and secondary data covering the 2008-09 and 2009-10 influenza seasons.

Study design: We estimated weekly monovalent influenza vaccine uptake in Maine and 15 other states, using difference-in-difference-in-differences analysis to assess the program's impact on immunization among six age groups. We also developed a health and economic Markov microsimulation model and conducted Monte Carlo sensitivity analysis.

Data collection: We used national survey data to estimate the impact of the SIV program on vaccine coverage. We used primary data and published studies to develop the microsimulation model.

Principal findings: The program was associated with higher immunization among children and lower immunization among adults aged 18-49 years and 65 and older. The program prevented 4,600 influenza infections and generated $4.9 million in net economic benefits. Cost savings from lower adult vaccination accounted for 54 percent of the economic gain. Economic benefits were positive in 98 percent of Monte Carlo simulations.

Conclusions: SIV may be a cost-beneficial approach to increase immunization during pandemics, but programs should be designed to prevent lower immunization among nontargeted groups.

Keywords: Pandemics; economic evaluation; immunization.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Child
  • Child, Preschool
  • Cost of Illness
  • Cost-Benefit Analysis
  • Female
  • Humans
  • Immunization Programs / economics*
  • Immunization Programs / organization & administration
  • Infant
  • Influenza A Virus, H1N1 Subtype
  • Influenza Vaccines / economics*
  • Influenza, Human / economics*
  • Influenza, Human / prevention & control*
  • Maine / epidemiology
  • Male
  • Middle Aged
  • Models, Economic
  • Monte Carlo Method
  • Pandemics
  • School Health Services / economics*
  • School Health Services / organization & administration
  • Young Adult


  • Influenza Vaccines