Cost effectiveness of a practice-based intervention to improve vaccination rates in adults less than 65-years-old. Issue 10 (3rd October 2017)

• Record Type: Journal Article
• Authors: Smith, Kenneth J.; Nowalk, Mary Patricia; Lin, Chyongchiou J.; Zimmerman, Richard K.
• Is Part Of: Human vaccines & immunotherapeutics. Volume 13:Issue 10(2017)
• Page Start: 2207
• Page End: 2212
• Publication Date: 2017-10-03
• Subjects: adult vaccination -- influenza vaccination -- cost-effectiveness analysis -- pertussis vaccination; Vaccines -- Periodicals; 615.372
• DOI: 10.1080/21645515.2017.1356526
• Languages: English
• ISSNs: 2164-5515

Abstract

ABSTRACT: The cost-effectiveness of the 4 Pillars™ Practice Transformation Program to improve vaccination rates in adults <65-years-old is unknown. Two vaccines, influenza and Tdap (tetanus, diphtheria, acellular pertussis), were targeted for this age group. Cost-effectiveness of the intervention compared with control, with a primary outcome of cost per quality adjusted life year (QALY) gained, was estimated from societal and third party payer perspectives over a 10-year time horizon using a decision analysis model. Vaccination rates and intervention costs were derived from an intervention trial, and vaccine effectiveness, illness rates, and costs with/without vaccination were obtained from US databases and literature data. Future costs and effectiveness were discounted at 3%/year. The intervention cost was $1.78 per eligible patient/year. From the societal perspective, per patient total vaccination and illness costs with the intervention were $27.43 higher than control while gaining 0.00087 QALYs, costing $31, 700/QALY gained. The intervention, extrapolated to the US population, could prevent 4.2 million cases, 87, 489 hospitalizations, and 5, 680 deaths due to influenza over 10 y in adults <65-years-old. In a probabilistic sensitivity analysis, the intervention was favored in 68.2% of model runs at a $50, 000/QALY level and in 94.3% at $100, 000/QALY. In a separate scenario analysis, the intervention became cost saving if influenza economic burden was >$2, 099 per case (societal base case $846). Thus, the 4 Pillars Practice Transformation Program is an economically reasonable intervention to improve vaccination rates in adults <65-years-old, and could have a substantial public health impact.