Economic analysis of a child vaccination project among Asian Americans in Philadelphia, Pa

Objective: To ascertain the cost-effectiveness and the benefit-cost ratios of a community-based hepatitis B vaccination catch-up project for Asian Ame rican children conducted in Philadelphia, Pa, from October 1, 1994, to Febr uary 11, 1996. Design: Program evaluation. Setting: South and southwest districts of Philadelphia Participants: A total of 4384 Asian American children. Interventions: Staff in the community-based organizations (1) educated pare nts about the hepatitis B vaccination, (2) enrolled physicians in the Vacci nes for Children program, and (3) visited homes of children due for a vacci ne dose. Staff in the Philadelphia Department of Public Health developed a computerized database; sent reminder letters for children due for a vaccine dose; and offered vaccinations in public clinics, health fairs, and homes. Main Outcome Measures: The numbers of children having received 1, 2, or 3 d oses of vaccine before and after the interventions; costs incurred by the P hiladelphia Department of Public Health and the community-based organizatio ns for design, education, and outreach activities; the cost of the vaccinat ion; cost-effectiveness ratios for intermediate outcomes (ie, per child, pe r dose, per immunoequivalent patient, and per completed series); discounted cost per discounted year of life saved; and the benefit-cost ratio of the project. Results: For the completed series of 3 doses, coverage increased by 12 perc entage points at a total cost of $268660 for design, education, outreach, a nd vaccination. Costs per child, per dose, and per completed series were $6 4, $119, and $537, respectively. The discounted cost per discounted year of life saved was $11525, and 106 years of life were saved through this inter vention. The benefit-cost ratio was 4.44:1. Conclusion: Although the increase in coverage was modest, the intervention proved cost-effective and cost-beneficial.