title: Cost-Effectiveness of the 4 Pillars Practice Transformation Program to Improve Vaccination of Adults Aged 65 and Older.
abstract: OBJECTIVE
  To estimate the cost-effectiveness of an intervention to increase pneumococcal, influenza, and pertussis-containing vaccine uptake in adults aged 65 and older in primary care practices.
  
  
  METHODS
  Markov decision analysis model, comparing the cost-effectiveness of the 4 Pillars Practice Transformation Program with no intervention.
  
  
  METHODS
  Diverse primary care practices in two U.S. cities.
  
  
  METHODS
  Clinical trial participants aged 65 and older.
  
  
  METHODS
  Quality-adjusted life years (QALYs), public health outcomes, and costs. Vaccination rates and intervention costs were derived from a randomized controlled cluster trial. Other parameters were derived from the medical literature and Centers for Disease Control and Prevention data. All parameters were individually and simultaneously varied over their distributions.
  
  
  RESULTS
  With the intervention program and extrapolating over 10 years, there would be approximately 60,920 fewer influenza cases, 2,031 fewer pertussis cases, and 13,842 fewer pneumococcal illnesses in adults aged 65 and older. Total per-person vaccination and illness costs with the intervention were $23.93 higher than without the intervention, with a concurrent increase in effectiveness of 0.0031 QALYs, or $7,635 per QALY gained. In sensitivity analyses, no individual parameter variation caused the intervention to cost more than $50,000 per QALY gained.
  
  
  CONCLUSIONS
  Implementing an intervention based on the 4 Pillars Practice Transformation Program is a cost-effective undertaking in primary care practices for individuals aged 65 and older, with predicted public health benefits.
authors.affiliation: Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Smith
authors.affiliation: Department of Family Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Zimmerman
authors.affiliation: Department of Family Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Mary Patricia
authors.initials: MP
authors.lastname: Nowalk
authors.affiliation: Department of Family Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Chyongchiou J
authors.initials: CJ
authors.lastname: Lin
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000191:economics*; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D007252:Influenza Vaccines / Q000191:economics*; D007251:Influenza, Human / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D008390:Markov Chains; D010414:Pennsylvania / Q000453:epidemiology; D011008:Pneumococcal Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000191:economics*; D019057:Quality-Adjusted Life Years; D013781:Texas / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014917:Whooping Cough / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines; D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines
keywords: Tdap vaccine; adult vaccination; cost-effectiveness; influenza vaccine; pneumococcal vaccine