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Marcia Weaver, PhD, MA; James Krieger, MD, MPH; Joseph Castorina, MD, MPH; Mary Walls, MPH; Sandy Ciske, MN

Arch Intern Med. 2001;161:111-120.

Background  We conducted a cost-effectiveness analysis as part of a randomized, controlled trial of a community-based outreach initiative to promote the pneumococcal and influenza vaccines for people aged 65 years or older.

Methods  The analysis was based on primary data from the trial on the increase in vaccination rates and cost of the intervention, and published estimates of the effectiveness of the vaccines and cost of treatment. We performed partial stochastic analyses based on the confidence intervals (CIs) of the effectiveness of the intervention and of the vaccines.

Results  The cost-effectiveness ratio of the combined-outreach initiative as implemented was $35 486 per quality-adjusted life-year (QALY), whereas it was $53 547 per QALY for the pneumococcal vaccine and $130 908 per QALY for the influenza vaccine. In partial stochastic analyses, the quasi-CI of the combined-outreach initiative ranged from $15 145 to $152 311 per QALY. The cost-effectiveness ratio of the intervention targeted to people who had never received the pneumococcal vaccine or who had not received the influenza vaccine in the previous year was $11 771 per QALY, with a quasi-CI of $3330 to $46 095 per QALY. With the use of the projected cost of replicating the intervention, the cost-effectiveness ratio was $26 512 per QALY for the initiative as implemented and $7843 per QALY for a targeted initiative.

Conclusions  The community-based outreach initiative to promote the pneumococcal and influenza vaccines was reasonably cost-effective. Further improvements in cost-effectiveness could be made by targeting the initiative or through lessons learned during the first year that would reduce the cost of the initiative in subsequent years.

From Public Health: Seattle & King County, Seattle, Wash (Drs Weaver and Krieger and Ms Ciske); Departments of Health Services (Drs Weaver and Krieger), Medicine (Dr Krieger), and Psychosocial and Community Health Nursing (Ms Ciske) and Nursing School (Ms Walls), University of Washington, Seattle; and Northeast Health Care Quality Foundation, Dover, NH (Dr Castorina).

Corresponding author: Marcia Weaver, PhD, MA, 937 Broadway Ave E, Seattle, WA 98102 (e-mail: mweaver{at}u.washington.edu).

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