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Estimating the cost-effectiveness of a national program to eliminate disparities in influenza vaccination rates among elderly minority groups

Michaelidis, Constantinos I., Zimmerman, Richard K., Nowalk, Mary Patricia, Smith, Kenneth J.
Vaccine 2011 v.29 no.19 pp. 3525-3530
African Americans, Hispanics, Markov chain, Whites, cost effectiveness, elderly, influenza, minorities (people), models, morbidity, mortality, quality-adjusted life year, vaccination, vaccines, willingness to pay, United States
Influenza is a major cause of preventable morbidity and mortality in the United States, particularly among the elderly. Yet, there remain large disparities in influenza vaccination rates across elderly Caucasian (70%), African-American (50%) and Hispanic (55%) populations, with substantial mortality consequences. In this study, we built a decision-analysis model to estimate the cost-effectiveness of a hypothetical national vaccination program designed to eliminate these disparities in influenza vaccination rates. Taking a societal perspective, we developed a Markov model with a one-year cycle length and lifetime time horizon. In the base case, we conservatively assumed that the cost of promoting the vaccination program was $10 per targeted elder per year and that by year 10, the vaccination rate of the elderly African-American and Hispanic populations would equal the vaccination rate of the elderly Caucasian population (70%). The cost-effectiveness of the vaccination program compared to no vaccination program was $48,617 per QALY saved. Probabilistic sensitivity analyses suggested that at willingness-to-pay thresholds of $50,000 and $100,000 per QALY saved, the likelihood of the vaccination program being cost-effective was 38% and 92%, respectively. In an analysis using conservative assumptions, we found that a hypothetical program to ameliorate disparities in influenza vaccination rates has a moderate to high likelihood of being cost-effective.