title: A cost-effectiveness analysis of pneumococcal vaccination in street-involved, HIV-infected patients.
abstract: BACKGROUND
  Delivery of the pneumococcal vaccine (PCV) to street-involved, HIV patients in British Columbia is low due to poor compliance. Since the use of PCV is expected to reduce morbidity and mortality, it may be more cost-effective to provide the vaccine directly to clinics.
  
  
  METHODS
  Three strategies were compared for a cohort of 5000 patients: 1) administering PCV at the clinics; 2) giving a prescription for PCV and expecting patients to fill it at a pharmacy and return for administration; and 3) no administration of vaccine. Decision analysis was utilized to map the costs and outcomes of the patients over 5 years and conduct an incremental cost-effectiveness analysis from the perspective of the Ministry of Health.
  
  
  RESULTS
  The average cost per patient was the lowest in Strategy 1 ($549) compared to Strategy 2 ($702) and Strategy 3 ($714). For the cohort, Strategy 1 prevented 269 and 299 additional cases of pneumococcal disease and resulted in a cost savings of $535,000 and $595,000 in direct medical costs when compared to Strategies 2 and 3, respectively. The model was robust to extensive sensitivity analyses.
  
  
  CONCLUSIONS
  The Ministry of Health should supply PCV to clinics involved in the care of street-involved HIV patients as this is the most cost-effective strategy.
authors.affiliation: Department of Pharmacy, Vancouver Hospital and Health Sciences Centre, BC.
authors.forename: C A
authors.initials: CA
authors.lastname: Marra
authors.forename: D M
authors.initials: DM
authors.lastname: Patrick
authors.forename: F
authors.initials: F
authors.lastname: Marra
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000382:microbiology / Q000517:prevention & control*; D001955:British Columbia; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D015658:HIV Infections / Q000150:complications*; D006302:Health Services Research; D006703:Ill-Housed Persons; D006801:Humans; D009313:National Health Programs; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D018410:Pneumonia, Bacterial / Q000150:complications / Q000382:microbiology / Q000517:prevention & control*; D013296:Streptococcus pneumoniae / Q000302:isolation & purification
chemical_list: D022242:Pneumococcal Vaccines