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A registered nurse injects a dose of the H1N1 flu vaccine at a Toronto health clinic on Thursday, October 29, 2009Darren Calabrese

A new study says Ontario's H1N1 vaccination program averted nearly one million cases and as many as 50 deaths.

The study says Ontario could have seen an additional 420 hospitalizations, 28,000 visits to hospital emergency departments and 100,000 visits to doctors' offices if it hadn't offered the flu shot program

The study was done by Beate Sanders, a health economist with the Ontario Agency of Health Protection and Promotion and was published in the journal Vaccine.

Sanders says that while the $180-million vaccination program was expensive, it was cost-effective.

Sanders notes, though, that if the vaccine had arrived any later the program wouldn't have been as cost-effective as it was.

That's because Ontario started vaccinating just before the peak of the second wave of H1N1 infections and a lot of people had already sick at that point.