Reducing medical service utilization by encouraging vaccines: randomized controlled trial.
BACKGROUND
Vaccination against influenza is associated with reductions in hospitalizations for heart disease, cerebrovascular disease, pneumonia, or influenza, and the risk of death from all causes during the influenza season.


METHODS
Randomized controlled trial.


METHODS
All members enrolled in the Blue Cross Blue Shield Association's Government Wide Service Benefit Program in the states of Oklahoma, Rhode Island, Kentucky, California, Arizona, Utah, and Colorado in October 2002. The sample size was 339,220 members.


METHODS
Two identical influenza/pneumonia direct mail marketing pieces that encouraged members to receive influenza and pneumococcal vaccinations. The study period was October 15, 2002 through March 15, 2003 when most influenza cases occur. Data were collected in July 2003 and analyzed during August 2003.


METHODS
Administrative claims based on influenza/pneumonia inpatient admissions and emergency department (ED) visits.


RESULTS
The intervention group experienced a 2.62% (p=0.010) higher rate of influenza vaccinations; 4.61% (p=0.080) higher rate of pneumonia vaccinations; 9.67% (p=0.136) lower rate of influenza/pneumonia inpatient admissions; and 22.64% (p=0.002) lower rate of influenza/pneumonia ED visits compared to the control group. The benefit-cost ratio (return on investment) from this intervention was estimated to be US dollar 2.21 per dollar spent.


CONCLUSIONS
Administrative claims data suggest that members respond to health plan mailings with an increase in influenza vaccination rates. Health plans can cost-effectively impact medical service utilization and vaccination rates by mailing information to their members.
McKesson Corporation, Broomfield, Colorado 80021, USA. Greg.Berg@McKesson.com
Gregory D
GD
Berg
Eileen
E
Thomas
Steven
S
Silverstein
Cheryl L
CL
Neel
Matthew
M
Mireles
D000293:Adolescent; D000328:Adult; D000368:Aged; D054598:Blue Cross Blue Shield Insurance Plans; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006293:Health Promotion; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage* / Q000191:economics; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D022242:Pneumococcal Vaccines / Q000008:administration & dosage* / Q000191:economics; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology / Q000517:prevention & control; D014481:United States / Q000453:epidemiology; D014611:Vaccination / Q000706:statistics & numerical data
D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines