Cost utility of public clinics to increase pneumococcal vaccines in the elderly.
BACKGROUND
Pneumococcal immunization has been shown to be cost effective, is recommended by the Advisory Committee on Immunization Practices, and is covered by Medicare. Despite that, over 50% of the population aged > or =65 is not vaccinated, leading to significant mortality and morbidity. The objective of this study is to evaluate the costs and the cost utility of immunization in nontraditional settings (community clinics set up to provide influenza and pneumococcal vaccinations) as a strategy to increase pneumococcal immunization rates.


METHODS
A cost-utility analysis of public immunization clinics in Monroe County, New York, during the fall of 1998. The study included 1207 adults aged > or =65. Costs of operating the clinics and of vaccine administration were measured. The cost of health sequela and estimates of quality-adjusted life years (QALYs) were obtained from prior studies. Sensitivity analyses were performed to test several important assumptions.


RESULTS
Unlike immunizations in physician offices, immunizations in nontraditional settings are not cost saving. Estimates of incremental cost-utility ratios ranged from $4215 per QALY to $12,617 per QALY, depending on the underlying assumptions of the model.


CONCLUSIONS
Clinics in nontraditional settings offering pneumococcal immunization have cost-utility ratios near and below those of other recommended vaccines. These results suggest that such clinics should be considered a viable strategy for increasing pneumococcal immunization rates.
Mukamel
D B
DB
University of Rochester Medical Center, Department of Community & Preventive Medicine, Rochester, New York 14642, USA. Dana_Mukamel@urmc.rochester.edu
Gold
H T
HT
Bennett
N M
NM
D000368:Aged; D003151:Community Health Centers / Q000191:economics* / Q000592:standards; D003362:Cost-Benefit Analysis; D017048:Health Care Costs / Q000706:statistics & numerical data; D006302:Health Services Research; D006299:Health Services for the Aged / Q000191:economics* / Q000592:standards; D006801:Humans; D007114:Immunization / Q000191:economics* / Q000706:statistics & numerical data; D009518:New York; D022242:Pneumococcal Vaccines / Q000191:economics*; D015397:Program Evaluation; D015980:Public Health Practice / Q000191:economics* / Q000592:standards; D011785:Quality Assurance, Health Care; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity
D022242:Pneumococcal Vaccines