Cost-effectiveness of programs to eliminate disparities in elderly vaccination rates in the United States

BMC Public Health

Kenneth J Smith³  Mary Patricia Nowalk¹  Richard K Zimmerman¹  Constantinos I Michaelidis² 

[1] Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA;University of Pittsburgh School of Medicine, M240 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA;Section of Decision Sciences and Clinical Systems Modeling, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

关键词: Cost-effectiveness;    Disparities;    Elderly;    Vaccination;   

Others  :  866272
DOI  :  10.1186/1471-2458-14-718

 received in 2013-12-16, accepted in 2014-07-10,  发布年份 2014

【 摘 要 】

Background

There are disparities in influenza and pneumococcal vaccination rates among elderly minority groups and little guidance as to which intervention or combination of interventions to eliminate these disparities is likely to be most cost-effective. Here, we evaluate the cost-effectiveness of four hypothetical vaccination programs designed to eliminate disparities in elderly vaccination rates and differing in the number of interventions.

Methods

We developed a Markov model in which we assumed a healthcare system perspective, 10-year vaccination program and lifetime time horizon. The cohort was the combined African-American and Hispanic 65 year-old birth cohort in the United States in 2009. We evaluated five different vaccination strategies: no vaccination program and four vaccination programs that varied from “low intensity” to “very high intensity” based on the number of interventions deployed in each program, their cumulative cost and their cumulative impact on elderly minority influenza and pneumococcal vaccination rates.

Results

The very high intensity vaccination program ($24,479/quality-adjusted life year; QALY) was preferred at willingness-to-pay-thresholds of $50,000 and $100,000/QALY and prevented 37,178 influenza cases, 342 influenza deaths, 1,158 invasive pneumococcal disease (IPD) cases and 174 IPD deaths over the birth cohort’s lifetime. In one-way sensitivity analyses, the very high intensity program only became cost-prohibitive (>$100,000/QALY) at less likely values for the influenza vaccination rates achieved in year 10 of the high intensity (>73.5%) or very high intensity (<76.8%) vaccination programs.

Conclusions

A practice-based vaccination program designed to eliminate disparities in elderly minority vaccination rates and including four interventions would be cost-effective.

【 授权许可】

   
2014 Michaelidis et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Thompson WW, Shay DK, Weintraub E, Brammer L, Bridges CB, Cox NJ, Fukuda K: Influenza-associated hospitalizations in the United States. JAMA 2004, 292(11):1333-1340.
• [2]Thompson WW, Shay DK, Weintraub E, Brammer L, Cox N, Anderson LJ, Fukuda K: Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA 2003, 289(2):179-86.
• [3]Active Bacterial Core Surveillance Report, 2006–2010. http://www.cdc.gov/abcs/reports-findings/surv-reports.html webcite
• [4]Gross PA, Hermogenes AW, Sacks HS, Lau J, Levandowski RA: The efficacy of influenza vaccine in elderly persons. A meta-analysis and review of the literature. Ann Intern Med 1995, 123:518-527.
• [5]Moberly SA, Holden J, Tatham DP, Andrews RM: Vaccines for preventing pneumococcal infection in adults. Cochrane Database Syst Rev 2008, 1:1-55. CD000422
• [6]Recent Influenza Vaccination Trends across Influenza Seasons: Estimates from the Behavioral Risk Factor Surveillance System (BRFSS), National Immunization Survey (NIS), and the National 2009 H1N1 Flu Survey (NHFS). CDC. http://www.cdc.gov/flu/professionals/ webcite
• [7]Adult Vaccination Coverage – United States, 2010. CDC. Morbidity and Mortality Weekly Report (MMWR) February 3, 2012. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6104a2.htm webcite
• [8]Briss PA, Rodewald LE, Hinman AR, Shefer AM, Strikas RA, Bernier RR, Carande-Kulis VG, Yusuf HR, Ndiaye SM, Williams SM: Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults. The Task Force on Community Preventive Services. Am J Prev Med 2000, 18(1 Suppl):97-140.
• [9]Ndiaye SM, Hopkins DP, Shefer AM, Hinman AR, Briss PA, Rodewald L, Willis B: Interventions to improve influenza, pneumococcal polysaccharide, and hepatitis B vaccination coverage among high-risk adults: a systematic review. Am J Prev Med 2005, 28(5S):248-279.
• [10]Zimmerman RK, Nowalk MP, Raymund M, Tabbarah M, Hall DG, Wahrenberger JT, Wilson SA, Ricci EM: Tailored interventions to increase influenza vaccination in neighborhood health centers serving the disadvantaged. Am J Public Health 2003, 93(10):1699-1705.
• [11]Michaelidis CI, Zimmerman RK, Nowalk MP, Smith KJ: Estimating the cost-effectiveness of a national program to eliminate disparities in influenza vaccination rates among elderly minority groups. Vaccine 2011, 29(19):3525-3530.
• [12]Michaelidis CI, Zimmerman RK, Nowalk MP, Smith KJ: Cost-effectiveness of a program to eliminate disparities in pneumococcal vaccination rates in elderly minority populations: an exploratory analysis. Value in Health 2013, 16(2):311-317.
• [13]Gold MR, Siegel JE, Russell LB, Weinstein MC: Cost-Effectiveness in Health and Medicine. New York, NY: Oxford University Press; 1996.
• [14]Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, O’Brien MA, Johansen M, Grimshaw J, Oxman AD: Audit and feedback: effects on professional practice and healthcare outcomes (Review). Cochrane Database Syst Rev 2012, 6:1-214. CD000259
• [15]Vann JC, Szilagyi PG: Patient reminder and recall systems to improve immunization rates. Cochrane Database Syst Rev 2009, 3:1-71. CD003941
• [16]2011–2012 VA Influenza Manual, Department of Veterans Affairs. http://www.publichealth.va.gov/docs/flu/vaflumanual-2011.pdf webcite
• [17]Arias E: United States life tables, 2007. National vital statistics reports; vol 59 no 9. Hyattsville, Maryland: National Center for Health Statistics; 2011.
• [18]United States Census Bureau, 2009 Resident Population by Race. http://www.census.gov/popest/data/historical/2000s/vintage_2009 webcite
• [19]Franzini L, Rosenthal J, Spears W, Martin HS, Balderas L, Brown M, Milne G, Drutz J, Evans D, Kozinetz C, Oettigen B, Hanson C: Cost-effectiveness of childhood immunization reminder/recall systems in urban private practices. Pediatrics 2000, 106(1):177-183.
• [20]Middleton DB, Lin CJ, Smith KJ, Zimmerman RK, Nowalk MP, Roberts MS, Fox DE: Economic evaluation of standing order programs for pneumococcal vaccination of hospitalized elderly patients. Infect Control Hosp Epidemiol 2008, 29(5):385-394.
• [21]Salary.com. http://swz.salary.com/SalaryWizard/Medical-Assistant-Salary-Details.aspx webcite
• [22]Appel A, Everhart R, Mehler PS, MacKenzie TD: Lack of ethnic disparities in adult immunization rates among underserved older patients in an urban public health system. Med Care 2006, 44(11):1054-1058.
• [23]Rivetti D, Jefferson T, Thomas RE, Rudin M, Rivetti A, Di Pietrantonj C, Demicheli V: Vaccines for preventing influenza in the elderly (Review). Cochrane Database Syst Rev 2006, 2:1-84. CD004876
• [24]Smith KJ, Lee BY, Nowalk MP, Raymund M, Zimmerman RK: Cost-effectiveness of dual influenza and pneumococcal vaccination in 50-year-olds. Vaccine 2010, 28(48):7620-7625.
• [25]Jefferson T, Di Pietrantonj C, Al-Ansary LA, Ferroni E, Thorning S, Thomas RE: Vaccines for preventing influenza in the elderly (Review). Cochrane Database Syst Rev 2010, 2:1-117. CD004876
• [26]Molinari NM, Ortega-Sanchez IR, Messonnier ML, Thompson WW, Wortley PM, Weintraub E, Bridges CB: The annual impact of seasonal influenza in the US: measuring disease burden and costs. Vaccine 2007, 25(27):5086-5096.
• [27]Smith KJ, Zimmerman RK, Nowalk MP, Roberts MS: Age, revaccination, and tolerance effects on pneumococcal vaccination strategies in the elderly: a cost effectiveness analysis. Vaccine 2009, 27(24):3159-3164.
• [28]Lee BY, Tai JH, Bailey RR, Smith KJ: The timing of influenza vaccination for older adults (65 years and older). Vaccine 2009, 27(50):7110-7115.
• [29]Anderson WL, Armour BS, Finkelstein EA, Weiner JM: Estimates of state-level health-care expenditures associated with disability. Public Health Rep 2010, 125(1):44-51.
• [30]Jackson LA, Benson P, Sneller VP, Butler JC, Thompson RS, Chen RT, Lewis LS, Carlone G, DeStefano F, Holder P, Lezhava T, Williams WW: Safety of revaccination with pneumococcal polysaccharide vaccine. JAMA 1999, 281(3):243-248.
• [31]Smith KJ, Roberts MS: Cost-effectiveness of newer treatment strategies for influenza. Am J Med 2002, 113(4):300-307.
• [32]Evers SM, Ament AJ, Colombo GL, Kondradsen HB, Reinart RR, Sauerland D, Wittrup-Jensen K, Loiseau C, Fedson DS: Cost-effectiveness of pneumococcal vaccination for prevention of invasive pneumococcal disease in the elderly: an update for 10 Western European countries. Eur J Clin Microbiol Infect Dis 2007, 26(8):531-540.
• [33]Erickson P, Wilson R, Shannon I: Statistical Notes no. 7: Years of healthy life. In Healthy People 2000. Atlanta: Centers for Disease Control and Prevention, National Center for Health Statistics; 1995.
• [34]Sisk JE, Whang W, Butler JC, Sneller V, Whitney CG: Cost-effectiveness of vaccination against Invasive pneumococcal disease among people 50 through 64 years of age: role of comorbid conditions and race. Ann Intern Med 2003, 138(12):960-968.
• [35]Gold MR, Franks P, McCoy KI, Fryback DG: Toward consistency in cost-utility analysis: using national measures to create condition-specific values. Med Care 1998, 36(6):778-792.
• [36]Smith KJ, Zimmerman RK, Lin CJ, Nowalk MP, Feng-Shou K, McEllistrem MC, Roberts MS: Alternative strategies for adult pneumococcal polysaccharide vaccination: a cost-effectiveness analysis. Vaccine 2008, 26(11):1420-1431.
• [37]Hsu K, Pelton S, Karumuri S, Heisey-Grove D, Klein J, Massachusetts Department of Public Health Epidemiologists: Population-based surveillance for childhood invasive pneumococcal disease in the era of conjugate vaccines. Pediatr Infect Dis J 2005, 24(1):17-23.
• [38]Fry AM, Zell ER, Schuchat A, Butler JC, Whitney CG: Comparing potential benefits of new pneumococcal vaccines with the current polysaccharide vaccine in the elderly. Vaccine 2002, 21(3–4):303-311.
• [39]Braithwaite RS, Meltzer DO, King JT Jr, Leslie D, Roberts MS: What does the value of modern medicine say about the $50,000 per quality-adjusted life-year decision rule? Med Care 2008, 46(4):349-356.
• [40]Frame PS, Zimmer JG, Werth PL, Jackson Hall W, Eberly SW: Computer-based vs manual health maintenance tracking: a controlled study. Arch Fam Med 1994, 3(7):581-588.