title: Cost-effectiveness of a program to eliminate disparities in pneumococcal vaccination rates in elderly minority populations: an exploratory analysis.
abstract: OBJECTIVE
  Invasive pneumococcal disease is a major cause of preventable morbidity and mortality in the United States, particularly among the elderly (>65 years). There are large racial disparities in pneumococcal vaccination rates in this population. Here, we estimate the cost-effectiveness of a hypothetical national vaccination intervention program designed to eliminate racial disparities in pneumococcal vaccination in the elderly.
  
  
  METHODS
  In an exploratory analysis, a Markov decision-analysis model was developed, taking a societal perspective and assuming a 1-year cycle length, 10-year vaccination program duration, and lifetime time horizon. In the base-case analysis, it was conservatively assumed that vaccination program promotion costs were $10 per targeted minority elder per year, regardless of prior vaccination status and resulted in the elderly African American and Hispanic pneumococcal vaccination rate matching the elderly Caucasian vaccination rate (65%) in year 10 of the program.
  
  
  RESULTS
  The incremental cost-effectiveness of the vaccination program relative to no program was $45,161 per quality-adjusted life-year gained in the base-case analysis. In probabilistic sensitivity analyses, the likelihood of the vaccination program being cost-effective at willingness-to-pay thresholds of $50,000 and $100,000 per quality-adjusted life-year gained was 64% and 100%, respectively.
  
  
  CONCLUSIONS
  In a conservative analysis biased against the vaccination program, a national vaccination intervention program to ameliorate racial disparities in pneumococcal vaccination would be cost-effective.
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA. michaelidis.constant@medstudent.pitt.edu
authors.forename: Constantinos I
authors.initials: CI
authors.lastname: Michaelidis
authors.forename: Richard K
authors.initials: RK
authors.lastname: Zimmerman
authors.forename: Mary Patricia
authors.initials: MP
authors.lastname: Nowalk
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Smith
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D008390:Markov Chains; D054525:Minority Health / Q000191:economics* / Q000706:statistics & numerical data; D018803:Models, Economic; D011008:Pneumococcal Infections / Q000191:economics* / Q000208:ethnology / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000191:economics*; D019057:Quality-Adjusted Life Years; D014481:United States / Q000453:epidemiology
chemical_list: D022242:Pneumococcal Vaccines
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