title: Cost-effectiveness of programs to eliminate disparities in elderly vaccination rates in the United States.
abstract: BACKGROUND
  There are disparities in influenza and pneumococcal vaccination rates among elderly minority groups and little guidance as to which intervention or combination of interventions to eliminate these disparities is likely to be most cost-effective. Here, we evaluate the cost-effectiveness of four hypothetical vaccination programs designed to eliminate disparities in elderly vaccination rates and differing in the number of interventions.
  
  
  METHODS
  We developed a Markov model in which we assumed a healthcare system perspective, 10-year vaccination program and lifetime time horizon. The cohort was the combined African-American and Hispanic 65 year-old birth cohort in the United States in 2009. We evaluated five different vaccination strategies: no vaccination program and four vaccination programs that varied from "low intensity" to "very high intensity" based on the number of interventions deployed in each program, their cumulative cost and their cumulative impact on elderly minority influenza and pneumococcal vaccination rates.
  
  
  RESULTS
  The very high intensity vaccination program ($24,479/quality-adjusted life year; QALY) was preferred at willingness-to-pay-thresholds of $50,000 and $100,000/QALY and prevented 37,178 influenza cases, 342 influenza deaths, 1,158 invasive pneumococcal disease (IPD) cases and 174 IPD deaths over the birth cohort's lifetime. In one-way sensitivity analyses, the very high intensity program only became cost-prohibitive (>$100,000/QALY) at less likely values for the influenza vaccination rates achieved in year 10 of the high intensity (>73.5%) or very high intensity (<76.8%) vaccination programs.
  
  
  CONCLUSIONS
  A practice-based vaccination program designed to eliminate disparities in elderly minority vaccination rates and including four interventions would be cost-effective.
authors.affiliation: University of Pittsburgh School of Medicine, M240 Scaife Hall, 3550 Terrace Street, 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: D001741:Black or African American; D000368:Aged; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D006299:Health Services for the Aged; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D007251:Influenza, Human / Q000208:ethnology / Q000401:mortality / Q000517:prevention & control*; D008390:Markov Chains; D008913:Minority Groups; D011008:Pneumococcal Infections / Q000208:ethnology / Q000401:mortality / Q000517:prevention & control*; D019057:Quality-Adjusted Life Years; D014481:United States; D014611:Vaccination / Q000191:economics*