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Cost-Effectiveness of Pneumococcal Vaccination Policies and Uptake Programs in US Older Populations.

Published on Feb 22, 2020in Journal of the American Geriatrics Society4.113
· DOI :10.1111/JGS.16373
Angela R. Wateska16
Estimated H-index: 16
(University of Pittsburgh),
Mary Patricia Nowalk36
Estimated H-index: 36
(University of Pittsburgh)
+ 4 AuthorsKenneth J. Smith30
Estimated H-index: 30
(University of Pittsburgh)
Abstract
BACKGROUND/OBJECTIVES: Recently revised vaccination recommendations for US adults, aged 65 years and older, include both 23-valent pneumococcal polysaccharide vaccine (PPSV23) and 13-valent pneumococcal conjugate vaccine (PCV13), with PCV13 now recommended for immunocompetent older people based on shared decision making. The public health impact and cost-effectiveness of this recommendation or of pneumococcal vaccine uptake improvement interventions are unclear. DESIGN: Markov decision analysis. SETTING AND PARTICIPANTS: Hypothetical 65-year-old general and black population cohorts. INTERVENTION: Current pneumococcal vaccination recommendations for US older people, an alternative policy omitting PCV13 in immunocompetent older people, and vaccine uptake improvement programs. RESULTS: The current pneumococcal vaccination recommendation was the most effective strategy, but afforded slight public health benefits compared to an alternative (PPSV23 for all older people plus PCV13 for the immunocompromised) and cost greater than 750 000 per quality-adjusted life-year (QALY) gained in either population group with a vaccine uptake improvement program (absolute uptake increase = 12.3%; cost = .78/eligible patient) in place. The alternative strategy was more economically favorable, but cost greater than 100 000/QALY in either population, with or without an uptake intervention. Results were robust in sensitivity analyses; however, in black older people, the alternative strategy with an uptake program was most likely to be favored in probabilistic sensitivity analyses at a 50 000/QALY gained threshold. CONCLUSION: Current pneumococcal vaccination recommendations for US older people are economically unfavorable compared to an alternative strategy omitting PCV13 in the immunocompetent. The alternative recommendation with an uptake improvement program may be economically reasonable in black population analyses and could be worth considering as a population-wide recommendation if mitigating racial disparities is a priority.
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References24
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#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: 30
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#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: 30
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Abstract Background Changing pneumococcal disease epidemiology due to childhood vaccination has prompted re-examination of US adult pneumococcal vaccination policies, as have considerations of greater pneumococcal disease incidence and higher prevalence of conditions that increase risk in underserved minority populations. Prior analyses suggest routine pneumococcal vaccination at age 50 could be considered, which could disproportionately benefit underserved populations. Methods A Markov cohort m...
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Background There exist racial and ethnic disparities in the prevalence of chronic medical illnesses. However, it is unclear if the disparities arise from patients’ self-reported estimates on these diseases and whether there is an association between healthcare utilization and diagnosis.
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The sustained health-related quality-of-life of patients surviving community-acquired pneumonia has not been accurately quantified. The aim of the current study was to quantify differences in health-related quality-of-life of community-dwelling elderly with and without community-acquired pneumonia during a 12-month follow-up period. In a matched cohort study design, nested in a prospective randomized double-blind placebo-controlled trial on the efficacy of the 13-valent pneumococcal vaccine in c...
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#1Kenneth J. Smith (University of Pittsburgh)H-Index: 30
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ABSTRACTThe 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 decis...
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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 ...
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#1Isaac See (CDC: Centers for Disease Control and Prevention)H-Index: 11
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Background: Invasive community-associated methicillin-resistant Staphylococcus aureus (MRSA) incidence in the United States is higher among black persons than white persons. We explored the extent to which socioeconomic factors might explain this racial disparity. Methods: A retrospective cohort was based on the Centers for Disease Control and Prevention's Emerging Infections Program surveillance data for invasive community-associated MRSA cases (isolated from a normally sterile site of an outpa...
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#1Richard K. Zimmerman (University of Pittsburgh)H-Index: 5
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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...
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