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

Michaelidis, CI and Zimmerman, RK and Nowalk, MP and Smith, KJ (2014) Cost-effectiveness of programs to eliminate disparities in elderly vaccination rates in the United States. BMC Public Health, 14 (1).

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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. © 2014 Michaelidis et al.; licensee BioMed Central Ltd.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Michaelidis, CI
Zimmerman, RKzimmer@pitt.eduZIMMER
Nowalk, MPTNOWALK@pitt.eduTNOWALK
Smith, KJkjs8@pitt.eduKJS8
Date: 15 July 2014
Date Type: Publication
Journal or Publication Title: BMC Public Health
Volume: 14
Number: 1
DOI or Unique Handle: 10.1186/1471-2458-14-718
Schools and Programs: School of Medicine > Family Medicine
School of Medicine > Medicine
Refereed: Yes
Date Deposited: 21 Dec 2016 20:43
Last Modified: 03 Feb 2019 02:55
URI: http://d-scholarship.pitt.edu/id/eprint/29532

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