PREVENTION OF ADENOVIRAL ACUTE RESPIRATORY-DISEASE IN ARMY RECRUITS -COST-EFFECTIVENESS OF A MILITARY VACCINATION POLICY

Introduction: Since 1971 widespread vaccination has limited the number of adenoviral acute respirator?; disease (ARD) outbreaks in Army recr uits, Increased vaccine costs have recently threatened the continuatio n of the vaccination program. Methods: We conducted a cost-effectivene ss analysis to assess the consequences of changing the year-round Army adenovirus vaccination program to (1) seasonally targeted vaccine adm inistration (only during the high-risk period) ol (2) complete discont inuation of the program from the perspective of total cost to the Army . Costs included vaccination costs and direct and indirect medical and military training costs. Health outcomes were estimated as the number of hospitalizations for ARD prevented, In the reference case, the inc idence rate among unvaccinated and vaccinated individuals was 4.06 and 1.5 per 100 person weeks, respectively. Results are expressed for a c ohort of 76,171 recruits. Results: In the absence of adenoviral vaccin ation, a projected 12,370 cases of XRD hospitalization would occur, co sting $26.4 million annually, A seasonally targeted program would prev ent 7,800 cases of ARD and save $16.1 million over no vaccination. Yea r-round immunization would not prevent any additional cases but would save $15.5 million over no vaccination. Year-round vaccination would b ecome the cost-effective strategy if ARD incidence during the low-risk months were to increase. Conclusion: Vaccination of army recruits by any schedule was cost-saving due to the high level of prevented diseas e and averted hospitalizations. Even though a seasonally targeted prog ram provided the greatest cost-savings, year-round vaccination must re main an option due to the potential for adenoviral XRD outbreaks in th e low-risk period.