A cost-effectiveness analysis of pneumococcal vaccination in street-involved, HIV-infected patients

Background: Delivery of the pneumococcal g-vaccine (PCV) to street-involved , HIV patients :in British Columbia is low due to poor compliance. Since th e use of PCV is expected to reduce morbidity and mortality, it may be more cost,effective to provide the vaccine directly to clinics. Methods Three strategies were compared for a cohort of 5000 patients: 1) ad ministering PCV at the clinics; 2) giving a prescription for : PCV and expe cting patients to fill it at a pharmacy and return for administration; and 3) no administratian of vaccine. Decision analysis was utilized to map the costs and outcomes of the patients over 5 years and conduct an incremental cost-effectiveness analysis from the perspective of the Ministry of Health. Results: The average cost per patient was the lowest in Strategy 1 ($549) c ompared to Strategy 2 ($702) and Strategy 3 ($714). For the cohort, Strateg y 1 prevented 269 and 239 additional cases of pneumococcal disease and resu lted in a cost savings of $535,000 and $595,000 in direct medical costs whe n compared to Strategies 2 and 3, respectively. The model was robust to ext ensive sensitivity analyses. Conclusions: The Ministry of Health should supply PCV to clinics involved i n the care of street-involved HIV patients as this is the most cost-effecti ve strategy.