Cost-effectiveness of combined outreach for the pneumococcal and influenzavaccines

Background: We conducted a cost-effectiveness analysis as part of a randomi zed, controlled trial of a community-based outreach initiative to promote t he pneumococcal and influenza vaccines for people aged 65 years or older. Methods: The analysis was based on primary data from the trial on the incre ase in vaccination rates and cost of the intervention, and published estima tes of the effectiveness of the vaccines and cost of treatment. We performe d partial stochastic analyses based on the confidence intervals (CIs) of th e effectiveness of the intervention and of the vaccines. Results: The cost-effectiveness ratio of the combined-outreach initiative a s 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 fo r the influenza vaccine. In partial stochastic analyses, the quasi-CI of th e combined-outreach initiative ranged from $15145 to $152311 per QALY The c ost-effectiveness ratio of the intervention targeted to people who had neve r received the pneumococcal vaccine or who had not received the influenza v accine 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 ini tiative as implemented and $7843 per QALY for a targeted initiative. Conclusions: The community-based outreach initiative to promote the pneumoc occal and influenza vaccines was reasonably cost-effective. Further improve ments in cost-effectiveness could be made by targeting the initiative or th rough lessons learned during the first year that would reduce the cost of t he initiative in subsequent years.