An ounce of prevention is worth a pound of cure, the saying goes - but it may not always hold true when it comes to the flu.

Influenza vaccination for healthy working adults is “reasonable” from public health standpoint, but it is not necessarily a cost-saving measure, according to researchers. In general, antiviral treatment of the flu with amantadine (Symmetrel) is more cost-effective than preventive flu vaccination.

Drs. Michael B. Rothberg and David N. Rose, of Tufts University School of Medicine in Boston, compared outcomes of four strategies: annual flu vaccination, amantadine given when a case of flu is suspected, rapid testing for influenza infection followed by treatment with oseltamivir (Tamiflu) if results are positive, or no intervention.

They used reports from the World Health Organization and Centers for Disease Control and Prevention regarding week-by-week incidence of influenza-like illness for 1993 through 2002. They assumed that workers miss an average of 1.9 days for an influenza-like illness and that 40 percent of patients visit a physician within 48 hours of symptom onset.

Overall, amantadine was the least expensive strategy at $234 per person per year, whereas vaccination costs averaged out to $239 per person, according to the team’s report in the American Journal of Medicine.

For every influenza season except 1997-1998, however, annual vaccination was the most effective strategy in keeping workers on the job and out of the hospital, and in four seasons it was the least expensive.

“If vaccination cost was less than $16 or time lost from work exceeded 2.4 days per episode of influenza, then vaccination was cost saving compared with all other strategies,” the investigators add.

No intervention was the least effective and most expensive option.

“Encouraging employees to seek prompt medical attention for fever and cough during the influenza season appears to save money, even for patients who have already been vaccinated, especially in years when the vaccine is not well matched to circulating strains of influenza,” Rothberg and Rose conclude.

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SOURCE: American Journal of Medicine, January 2005.