Cost Effectiveness of the 4 Pillars™ Practice Transformation Program to Improve Vaccination of Adults Aged ≥65 years

Details

• Alternative Title:
  J Am Geriatr Soc
• Personal Author:
  Smith, Kenneth J. ; Zimmerman, Richard K. ; Nowalk, Mary Patricia ; Lin, Chyongchiou J.
• Description:
  Objectives
  
  Interventions to improve adult vaccination uptake in primary care have met with limited success, raising questions about whether the benefits to patients are worth the time and resources necessary to implement them. Here we examine the cost effectiveness of an intervention to increase pneumococcal, influenza and pertussis-containing vaccine uptake among adults ≥65 years of age in primary care practices.
  
  Design
  
  Markov decision analysis model, estimating the cost-effectiveness of the 4 Pillars™ Practice Transformation Program compared with no intervention.
  
  Setting
  
  Diverse primary care practices in 2 US cities
  
  Participants
  
  Clinical trial patients aged 65 years and older. Vaccination rates and intervention costs were derived from a randomized controlled cluster trial. Other parameters were derived from the medical literature and CDC data. All parameters were individually and simultaneously varied over their distributions.
  
  Measurements
  
  Quality adjusted life years (QALYs), public health outcomes, and costs
  
  Results
  
  With the intervention program and extrapolating over 10 years, there would be ~60,920 fewer influenza cases, 2,031 fewer pertussis cases, and 13,842 fewer pneumococcal illnesses among adults ≥65 years. Compared to no intervention, total per-person vaccination and illness costs with the intervention were $1.60 higher with a concurrent increase in effectiveness of 0.0031 QALYs, or $512 per QALY gained. In sensitivity analyses, no individual parameter variation caused the intervention to cost >$20,000 per QALY gained.
  
  Conclusions
  
  Implementing an intervention based on the 4 Pillars™ Practice Transformation Program is a cost-effective undertaking in primary care practices for patients ≥65 years old with predicted public health benefits.
  
  
• Subjects:
  Aged Cost-Benefit Analysis Diphtheria-Tetanus-acellular Pertussis Vaccines Female Humans Immunization Programs Influenza, Human Influenza Vaccines Male Markov Chains Pennsylvania Pneumococcal Infections Pneumococcal Vaccines Quality-Adjusted Life Years Whooping Cough

  More +
• Source:
  J Am Geriatr Soc. 65(4):763-768.
• Pubmed ID:
  28024090
• Pubmed Central ID:
  PMC5397321
• Document Type:
  Journal Article
• Funding:
  R01 AI116575/AI/NIAID NIH HHS/United States ; U01 IP000662/IP/NCIRD CDC HHS/United States ; UL1 RR024153/RR/NCRR NIH HHS/United States ; UL1 TR000005/TR/NCATS NIH HHS/United States
• Place as Subject:
  Texas ; United States
• Volume:
  65
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:6f4f200130e9c9ee78ab1571e5f1ab8ae24db9094e45f2bd5798d3e3a30a90c8
• Download URL:
  https://stacks.cdc.gov/view/cdc/45414/cdc_45414_DS1.pdf
• File Type:
  [PDF - 82.58 KB ]