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Feature Article

ER is cost-effective setting for flu vaccinations

The appearance of cold weather throughout much of the United States is not only a sign of approaching winter, it's also a sign that influenza season is with us once again. In the United States, annual outbreaks of flu usually occur during the fall, winter, and early spring. In a typical year, 5 to 20 percent of the population gets the seasonal flu.

Influenza is a serious illness. According to the Centers for Disease Control and Prevention (CDC), from 1976-77 through 2006-2007, flu-related deaths in the United States ranged from a low of about 3,000 to a high of about 49,000 people per year, and each year more than 200,000 people are hospitalized from the flu.i CDC recommends getting a yearly flu vaccination as the first and most important step in protecting against flu viruses.

Physicians and others have made extensive efforts to provide this yearly vaccination to Americans, especially older adults who are at greatest risk of serious illness and dying from the flu. VA, in particular, has set a goal of providing seasonal influenza vaccination to 85 percent of its health care employees, and to all Veteran patients.

Many people, however, are not vaccinated, and a team of researchers, led by Brian Patterson, MD, MPH, of Northwestern University and Todd A. Lee, PharmD, PhD, of the Hines (Ill.) VA Hospital used a statistical model to explore whether it would be cost-effective to offer flu vaccination to older adults in hospital emergency rooms. Their study was posted online on Sept. 9, 2011, in the American Journal of Emergency Medicine.ii

"Our findings show that vaccinating older adults in emergency departments is cost effective, especially for people who are more than 65 years old," said Lee. "Emergency departments may be an important setting for providing influenza vaccination to adults who may otherwise have remained unvaccinated."

The researchers compared three strategies: offering no vaccination at all; offering vaccinations to patients older than age 65; and vaccination to all patients who are 50 years old or more. They found that vaccinating patients 50 or older would cost hospitals approximately $35,000 for every life the vaccinations saved, and limiting vaccinations to those older than 65 was even more cost-effective: It would cost hospitals only $13,000 for every life such vaccinations saved.

In general, the flu vaccine is one of the most cost-effective health care interventions possible for the elderly, saving nearly $200 in medical costs for every person age 65 and older who is vaccinated, according to a 1994 study in the New England Journal of Medicine.iii Together, pneumonia and flu are the eighth leading cause of death in the United States and the sixth leading cause among older adults.iv

Besides getting vaccinated for the flu, there are other ways people can keep from getting the disease. Covering the nose and mouth when coughing or sneezing; washing hands often with soap and water; avoiding touching the eyes, nose and mouth; and staying home and limiting contact with others when ill are among preventive actions everyone can take to stop the spread of germs.

Those who do get the flu should take antiviral drugs prescribed by their physician. These medicines can make the illness milder and shorten the length of time of the illness—and prevent complications like pneumonia. Flu-like symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people also may have vomiting and diarrhea.

According to CDC, the best time to get vaccinated is before December, since this timing ensures that the protective antibodies the vaccine provides are in place before flu activity is typically at its highest. However, flu season can last as late as May, so getting vaccinated later in the flu season can still provide protective benefits. About two weeks after vaccination, antibodies that provide protection against the influenza viruses in the vaccine develop in the body. CDC recommends everyone six months or older should be vaccinated annually.


i CDC, National Center for Health Statistics, "Estimating Seasonal Influenza-Associated Deaths in the United States: CDC Study Confirms Variability of Flu" accessed from http://www.cdc.gov/flu/about/disease/us_flu-related_deaths.htm. ii BW Patterson, RK Khare, DM Courtney, TA Lee, DN Kyriacou, "Cost-effectiveness of influenza vaccination of older adults in the ED Setting." Am J Emeg Med, 2011 Sep 9. (Epub ahead of print.) iii KL Nichol, et al. "The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community," N Eng J Med (1994):331: 778-84. iv CDC, National Center for Health Statistics, Mortality Data from the National Vital Statistic System. Accessed from http://www.cdc.gov/nchs/deaths.htm September 10, 2007.

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Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.