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Cost-effectiveness of increasing vaccination in high-risk adults aged 18-64 Years: a model-based decision analysis.

Published on Dec 1, 2018in BMC Infectious Diseases2.565
· DOI :10.1186/s12879-018-2967-2
Angela R. Wateska16
Estimated H-index: 16
(University of Pittsburgh),
Mary Patricia Nowalk36
Estimated H-index: 36
(University of Pittsburgh)
+ 2 AuthorsChyongchiou J. Lin14
Estimated H-index: 14
(University of Pittsburgh)
Abstract
Adults aged 18–64 years with comorbid conditions are at high risk for complications of certain vaccine-preventable diseases, including influenza and pneumococcal disease. The 4 Pillars™ Practice Transformation Program (4 Pillars Program) increases uptake of pneumococcal polysaccharide vaccine, influenza vaccine and tetanus-diphtheria-acellular pertussis vaccine by 5–10% among adults with high-risk medical conditions, but its cost-effectiveness is unknown. A decision tree model estimated the cost-effectiveness of implementing the 4 Pillars Program in primary care practices compared to no program for a population of adults 18–64 years of age at high risk of illness complications over a 10 year time horizon. Vaccination rates and intervention costs were derived from a randomized controlled cluster trial in diverse practices in 2 U.S. cities. One-way and probabilistic sensitivity analyses were conducted. From a third-party payer perspective, which considers direct medical costs, the 4 Pillars Program cost $28,301 per quality-adjusted life year gained; from a societal perspective, which adds direct nonmedical and indirect costs, the program was cost saving and more effective than no intervention. Cost effectiveness results favoring the program were robust in sensitivity analyses. From a public health standpoint, the model predicted that the intervention reduced influenza cases by 1.4%, with smaller decreases in pertussis and pneumococcal disease cases. The 4 Pillars Practice Transformation Program is an economically reasonable, and perhaps cost saving, strategy for protecting the health of adults aged < 65 years with high-risk medical conditions
  • References (33)
  • Citations (3)
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References33
Newest
#1Mary HawkH-Index: 6
Last. Edmund M. RicciH-Index: 23
view all 8 authors...
Abstract:Adult immunization rates are consistently suboptimal, exacting significant human and financial burden of preventable disease. Practice-level interventions to improve immunization rates have produced mixed results. The context of change critically affects implementation of evidence-based int
4 CitationsSource
#1Kenneth J. Smith (University of Pittsburgh)H-Index: 27
#2Richard K. Zimmerman (University of Pittsburgh)H-Index: 4
Last. Chyongchiou J. Lin (University of Pittsburgh)H-Index: 14
view all 4 authors...
Objectives To estimate the cost-effectiveness of an intervention to increase pneumococcal, influenza, and pertussis-containing vaccine uptake in adults aged 65 and older in primary care practices. Design Markov decision analysis model, comparing the cost-effectiveness of the 4 Pillars Practice Transformation Program with no intervention. Setting Diverse primary care practices in two U.S. cities. Participants Clinical trial participants aged 65 and older. Measurements Quality-adjusted life years ...
4 CitationsSource
#1Richard K. Zimmerman (University of Pittsburgh)H-Index: 4
#2Anthony E. Brown (BCM: Baylor College of Medicine)H-Index: 9
Last. Mary Patricia Nowalk (University of Pittsburgh)H-Index: 5
view all 12 authors...
Objectives To test the effectiveness of a step-by step, evidence-based guide, the 4 Pillars Practice Transformation Program, to increase adult pneumococcal vaccination. Design Randomized controlled cluster trial (RCCT) in Year 1 (June 1, 2013 to May 31, 2014) and pre-post study in Year 2 (June 1, 2014 to January 31, 2015) with data analyzed in 2016. Baseline year was June 1, 2012, to May 31, 2013. Demographic and vaccination data were derived from deidentified electronic medical record extractio...
11 CitationsSource
#1Richard K. Zimmerman (University of Pittsburgh)H-Index: 35
#2Krissy K. Moehling (University of Pittsburgh)H-Index: 11
Last. Mary Patricia Nowalk (University of Pittsburgh)H-Index: 36
view all 8 authors...
Abstract Objective Uptake of meningococcal vaccine (MCV) and tetanus, diphtheria and pertussis (Tdap) vaccine among adolescents has approached Healthy People 2020 goals, but human papillomavirus (HPV) vaccination has not. This study evaluated an intervention using the 4 Pillars™ Practice Transformation Program to increase HPV, MCV and Tdap uptake among adolescents in primary care practices. Methods Practices with at least 50 patients 11–17 years old with estimated vaccination rates less than nat...
7 CitationsSource
#1Chyongchiou J. Lin (University of Pittsburgh)H-Index: 14
#2Mary Patricia Nowalk (University of Pittsburgh)H-Index: 36
Last. Richard K. Zimmerman (University of Pittsburgh)H-Index: 35
view all 13 authors...
Background An evidence-based, step-by-step guide, the 4 Pillars™ Practice Transformation Program, was the foundation of an intervention to increase adult immunizations in primary care and was tested in a randomized controlled cluster trial. The purpose of this study is to report changes in influenza immunization rates and on factors related to receipt of influenza vaccine.
9 CitationsSource
#1Gillian D Sanders (Duke University)H-Index: 43
#2Peter J. Neumann (Tufts Medical Center)H-Index: 81
Last. Theodore G. Ganjats (UM: University of Miami)H-Index: 58
view all 16 authors...
Importance Since publication of the report by the Panel on Cost-Effectiveness in Health and Medicine in 1996, researchers have advanced the methods of cost-effectiveness analysis, and policy makers have experimented with its application. The need to deliver health care efficiently and the importance of using analytic techniques to understand the clinical and economic consequences of strategies to improve health have increased in recent years. Objective To review the state of the field and provid...
489 CitationsSource
#1Mary Patricia Nowalk (University of Pittsburgh)H-Index: 36
#2Chyongchiou J. Lin (University of Pittsburgh)H-Index: 14
Last. Richard K. Zimmerman (University of Pittsburgh)H-Index: 35
view all 14 authors...
Abstract Introduction National adult Tdap vaccination rates are low, reinforcing the need to increase vaccination efforts in primary care offices. The 4 Pillars™ Practice Transformation Program is an evidence-based, step-by-step guide to improving primary care adult vaccination with an online implementation tracking dashboard. This study tested the effectiveness of an intervention to increase adult Tdap vaccination that included the 4 Pillars™ Program, provider education, and one-on-one coaching...
7 CitationsSource
#1Charles Stoecker (Tulane University)H-Index: 7
#2Lindsay Kim (CDC: Centers for Disease Control and Prevention)H-Index: 8
Last. Tamara Pilishvili (CDC: Centers for Disease Control and Prevention)H-Index: 21
view all 4 authors...
BACKGROUND Recently released results from a randomized controlled trial have shown that 13-valent pneumococcal conjugate vaccine (PCV13) is efficacious against vaccine-type nonbacteremic pneumonia in adults.
30 CitationsSource
#1W. W. WilliamsH-Index: 11
#2Peng-jun LuH-Index: 29
Last. Carolyn B. BridgesH-Index: 53
view all 12 authors...
Abstract Overall, the prevalence of illness attributable to vaccine-preventable diseases is greater among adults than among children. Adults are recommended to receive vaccinations based on their age, underlying medical conditions, lifestyle, prior vaccinations, and other considerations. Updated vaccination recommendations from CDC are published annually in the U.S. Adult Immunization Schedule. Despite longstanding recommendations for use of many vaccines, vaccination coverage among U.S. adults ...
232 CitationsSource
#1Mary Patricia Nowalk (University of Pittsburgh)H-Index: 5
#2Richard K. Zimmerman (University of Pittsburgh)H-Index: 4
Last. Norma J. Allred (National Center for Immunization and Respiratory Diseases)H-Index: 13
view all 10 authors...
Abstract Objective Influenza vaccination rates among some groups of children remain below the Healthy People 2020 goal of 70%. Multistrategy interventions to increase childhood influenza vaccination have not been evaluated recently. Methods Twenty pediatric and family medicine practices were randomly assigned to receive the intervention in either year 1 or year 2. This study focuses on influenza vaccine uptake in the 10 year 1 intervention sites during intervention and the following maintenance ...
5 CitationsSource
Cited By3
Newest
#1Angela R. Wateska (University of Pittsburgh)H-Index: 16
#2Mary Patricia Nowalk (University of Pittsburgh)H-Index: 36
Last. Kenneth J. Smith (University of Pittsburgh)H-Index: 27
view all 7 authors...
In US adults aged < 65 years, pneumococcal vaccination is recommended when high-risk conditions are present, but vaccine uptake is low. Additionally, there are race-based differences in illness risk and vaccination rates. The cost-effectiveness of programs to improve vaccine uptake or of alternative vaccination policies to increase protection is unclear. A decision analysis compared, in US black and general population cohorts aged 50 years, the public health impact and cost-effectiveness of pneu...
Source
#2Ana López-de-Andrés (URJC: King Juan Carlos University)H-Index: 21
Last. Rodrigo Jiménez-García (Complutense University of Madrid)
view all 7 authors...
ABSTRACTThe objectives of this study were to estimate coverage of influenza vaccination in Spain among adults suffering chronic conditions, to assess time trends from 2014 to 2017 and to identify v...
Source
#2Teresa AguadoH-Index: 8
view all 10 authors...
Abstract Vaccination beyond childhood brings significant benefits at the individual, community and socio-economic levels. Despite this, immunisation programmes often fail to deliver the vaccines which could protect those at risk of vaccine-preventable diseases. In this commentary, we argue that the benefits of vaccination beyond childhood must be more widely understood and furthermore, that action must be taken by policymakers, healthcare professionals and patient and civil society organisations...
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