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Cost‐Effectiveness of the 4 Pillars Practice Transformation Program to Improve Vaccination of Adults Aged 65 and Older
Author(s) -
Smith Kenneth J.,
Zimmerman Richard K.,
Nowalk Mary Patricia,
Lin Chyongchiou J.
Publication year - 2017
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.14588
Subject(s) - medicine , randomized controlled trial , quality adjusted life year , intervention (counseling) , public health , vaccination , cost effectiveness , health care , cost–benefit analysis , gerontology , quality of life (healthcare) , cost effectiveness analysis , family medicine , nursing , economics , immunology , ecology , risk analysis (engineering) , surgery , biology , economic growth
Objectives 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. Design Markov decision analysis model, comparing the cost‐effectiveness of the 4 Pillars Practice Transformation Program with no intervention. Setting Diverse primary care practices in two U.S. cities. Participants Clinical trial participants aged 65 and older. Measurements Quality‐adjusted life years ( QALY s), 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 QALY s, 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.