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BMC Public Health
Published in: BMC Public Health 1/2014

Open Access 01-12-2014 | Research article

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

Authors: Constantinos I Michaelidis, Richard K Zimmerman, Mary Patricia Nowalk, Kenneth J Smith

Published in: BMC Public Health | Issue 1/2014

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Abstract

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.
Appendix
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Literature
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.CrossRefPubMed
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.CrossRefPubMed
3.
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.CrossRefPubMed
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. 2009, http://​www.​cdc.​gov/​flu/​professionals/​, H1N1 Flu Survey (NHFS). CDC,
7.
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMedPubMedCentral
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.CrossRefPubMed
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.CrossRefPubMedPubMedCentral
13.
Gold MR, Siegel JE, Russell LB, Weinstein MC: Cost-Effectiveness in Health and Medicine. 1996, New York, NY: Oxford University Press
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.
17.
Arias E: United States life tables, 2007. National vital statistics reports; vol 59 no 9. 2011, Hyattsville, Maryland: National Center for Health Statistics
18.
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.PubMed
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.CrossRefPubMed
21.
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.CrossRefPubMed
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.CrossRefPubMedPubMedCentral
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.CrossRefPubMed
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.CrossRefPubMed
28.
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.PubMedPubMedCentral
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.CrossRefPubMed
31.
Smith KJ, Roberts MS: Cost-effectiveness of newer treatment strategies for influenza. Am J Med. 2002, 113 (4): 300-307.CrossRefPubMed
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.CrossRefPubMed
33.
Erickson P, Wilson R, Shannon I: Statistical Notes no. 7: Years of healthy life. Healthy People 2000. 1995, Atlanta: Centers for Disease Control and Prevention, National Center for Health Statistics
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
39.
Braithwaite RS, Meltzer DO, King JT, 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.CrossRefPubMed
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.CrossRefPubMed
Metadata
Title
Cost-effectiveness of programs to eliminate disparities in elderly vaccination rates in the United States
Authors
Constantinos I Michaelidis
Richard K Zimmerman
Mary Patricia Nowalk
Kenneth J Smith
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2014
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-14-718

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