The true cost of providing of providing an immunisation service in state run clinics

1. An estimate of the opportunity cost to the HSE of providing
Public Immunisation Clinics for the 2009 Influenza A (H1N1)
Pandemic
William Behan
To determine the total opportunity cost of reassigning public health resources to the Irish Pandemic
Influenza Immunisation Program a telephone survey was performed on Local Health Offices that a served a
total population of 1,101,000 (25.97% of the national population). It found that this cohort represented an
opportunity cost of approximately €5,205,170 or €34.73 per successfully administered immunisation to
cover the local staff salaries plus overheads over the 21.6 weeks of the campaign. This equates to a total
national opportunity cost of €20,044,623, not including the planning, media campaign, booking and I.T.
systems and vaccine or post campaign administrative costs.
Introduction.
A complete breakdown of the full cost of the HSE and Department of Health and Children Public Health Response to the
2009 Influenza A (H1N1) Pandemic has never been published. The 2010 National Service Plans attribute an extra cost of
€55 million to the HSE budget as a result of the pandemic 1
. This includes three million vaccines purchased at a cost of
€12.8 million 2
; a national media information campaign; expenses incurred due to increased hospital admissions and
costs associated with the planning and implementation of the National Pandemic Influenza Immunisation Campaign.
In late October 2009 the HSE started providing GPs interested in participating in the planned Pandemic Vaccination
Program with the Pandemrix vaccine so that they could vaccinate the high risk patients. It would set up 45 clinics
nationally to accommodate any high risk patients not otherwise vaccinated and the rest of the population starting on the
2nd November 2009 3
.
This paper estimates the opportunity cost of reassigning health resources to the HSE public clinic vaccination program.
That involves including the full cost of employing the medical, administrative and ancillary staff and associated overheads
that were transferred from their regular duties to work exclusively in the HSE public immunisation clinics over the 21.6
weeks they were in operation. Any opportunity costs associated with staff involved in the initial planning of the
immunisation campaign or staff that spent months completing and aggregating vaccine returns after March 30th are not
considered.
METHODS
Study Design was a Cross-sectional telephone survey. The Study Population were a random selection of 9 urban and rura
Local Health Offices representing 10 Local Health Areas; corresponding to an aggregate catchment population of
1,101,000 people according to 2006 CSO data. Data Collection was by the author and entailed telephoning the Local
Health Offices and interviewing staff who were involved in the organising and running of the local swine flu immunisation
clinic using a standardised questionnaire. Information requested included the catchment area population for each LHO
according to the 2006 CSO census. Also elicited were the medical, administrative and ancillary staffing arrangements of
each clinic to include the staff grade and whole time equivalent time worked over the 21.6 weeks for each staff member.
The full cost of employing each staff grade was extrapolated by applying the Department of Taoiseach 2009 Regulatory
Impact Analysis guidelines for assessing public service staff costs 4
.
This involves calculating a base salary for each grade by taking a cash value mid way between the scale minimum and
the highest point from the HSE document on 1st September 2008 consolidated salary scales 5
. These base salaries were
then multiplied by the number of whole time equivalents working at each grade for the 21.6 weeks. The product of all the
calculations for each grade was considered the aggregate basic salary cost for all the HSE staff in this cohort. To this sum
was added the Employers 10.75% PRSI , 25% basic salary in lieu of considered value of the public service pension at tha
time and also 40% basic salary in respect of ‘overheads’ to calculate a more realistic cost for the total staff cost to cover
the catchment population of 1,101,000. This sum was extrapolated in line with the 2006 CSO census population of
4,239,848 to provide an estimate of the total national HSE staff cost 6
.

2. Results
Category Medical Nursing
Senior
Hospital
SHO/ General/
Grade AMO AMO Community PHN Mental
Dentist Health
WTE over 21.6 weeks 1.1 19.9 2.6 50.25 5.5
Base Annual Salary 90,939 76,528 49,775 53,396 39,208
Category Clerical Officers Ancillary
Grade VI or Security/
Grade rarely VII or Grade V
Grade III-
IV
Principle
Environmental Porter/Cleaner/
Gen Manager Health Officer Caretaker
WTE over 21.6 weeks 5.2 4.25 51 0.4 7.1
Base Annual Salary 53,179 47,137 34,835 75,481 30,570
The aggregate base salary costs for all the staffs involved over 21.6 weeks is €2,961,690. Addition of the cost of PRSI,
pension and overheads brings the total staff costs to €5,205,170 for the catchment population of 1,101,000.
Extrapolation of this figure assumes a national staff and overheads cost of €20,044,623 for running the 45 clinics alone.
Discussion
955,118 individuals were recorded as vaccinated with influenza pandemic (H1N1) 2009 vaccine according to provisional
data, of which 378,041 were recorded as being vaccinated by General Practitioners. This means 577,077 individuals were
successfully immunised in the HSE mass vaccine clinics during the 21.6 weeks 7
. The total €20,044,623 opportunity cost
equates to €34.73 per vaccine administered. It does not include the opportunity costs of planning and coordinating the
whole program, developing and running the national IT and appointment systems or post campaign administrative costs.
Nor does it include the direct costs of the media campaign, the purchase and delivery of the vaccine or sending out
invitation letters to certain age groups.
Author's Correspondence
Dr William Behan, 115 Cromwellsfort Road, Walkinstown, Dublin 12.
Acknowledgement
None
Other References
1
http://www.hse.ie/eng/services/Publications/corporate/serviceplan.pdf Page 12.
2
http://www.irishexaminer.com/home/almost-2-million-swine-flu-jabs-went-unused-121870.html
3
http://www.hse.ie/eng/services/News/newsarchive/200920082007Archive/Nov_2009/itstops.html
4
http://www.taoiseach.gov.ie/eng/Publications/Publications_Archive/Publications_2011/Revised_RIA_G
uidelines_June_2009.pdf Page 76
5
http://www.hse.ie/eng/staff/Benefits_Services/pay/Sept2008.pdf
6
http://www.cso.ie/en/media/csoie/census/documents/Amended%20Final%20Principal

3. %20Demographic%20Results%202006.pdf
7
http://ndsc.newsweaver.ie/epiinsight/viz7qx9a6lrqkeph6tk9uv