Byung-Kwang Yoo1, Sharon G Humiston2, Peter G Szilagyi3, Stanley J Schaffer4, Christine Long5, Maureen Kolasa6. 1. Department of Public Health Sciences, University of California Davis, School of Medicine, One Shields Ave. Medical Sciences 1C, Davis, CA, 95616, USA. byoo@ucdavis.edu. 2. Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, 64108, USA. Sharon_Humiston@URMC.Rochester.edu. 3. Department of Pediatrics, University of California Los Angeles (UCLA), 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA. PSzilagyi@mednet.ucla.edu. 4. Department of Pediatrics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave., Rochester, NY, 14642, USA. Stanley_Schaffer@URMC.Rochester.edu. 5. Center for Community Health of the University of Rochester, 46 Prince Street, Suite 1001, Rochester, NY, 14607, USA. christine_long@urmc.rochester.edu. 6. Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, 30333, USA. mxk2@cdc.gov.
Abstract
BACKGROUND:School-located vaccination against influenza (SLV-I) has the potential to improve current suboptimal influenza immunization coverage for U.S. school-aged children. However, little is known about SLV-I's cost-effectiveness. The objective of this study is to establish the cost-effectiveness of SLV-I based on a two-year community-based randomized controlled trial (Year 1: 2009-2010 vaccination season, an unusual H1N1 pandemic influenza season, and Year 2: 2010-2011, a more typical influenza season). METHODS: We performed a cost-effectiveness analysis on a two-year randomized controlled trial of a Western New York SLV-I program. SLV-I clinics were offered in 21 intervention elementary schools (Year 1 n = 9,027; Year 2 n = 9,145 children) withstandard-of-care (no SLV-I) in control schools (Year 1 n = 4,534 (10 schools); Year 2 n = 4,796 children (11 schools)). We estimated the cost-per-vaccinated child, by dividing the incremental cost of the intervention by the incremental effectiveness (i.e., the number of additionally vaccinated students in intervention schools compared to control schools). RESULTS: In Years 1 and 2, respectively, the effectiveness measure (proportion of children vaccinated) was 11.2 and 12.0 percentage points higher in intervention (40.7 % and 40.4 %) than control schools. In year 2, the cost-per-vaccinated child excluding vaccine purchase ($59.88 in 2010 US $) consisted of three component costs: (A) the school costs ($8.25); (B) the project coordination costs ($32.33); and (C) the vendor costs excluding vaccine purchase ($16.68), summed through Monte Carlo simulation. Compared to Year 1, the two component costs (A) and (C) decreased, while the component cost (B) increased in Year 2. The cost-per-vaccinated child, excluding vaccine purchase, was $59.73 (Year 1) and $59.88 (Year 2, statistically indistinguishable from Year 1), higher than the published cost of providing influenza vaccination in medical practices ($39.54). However, taking indirect costs (e.g., averted parental costs to visit medical practices) into account, vaccination was less costly in SLV-I ($23.96 in Year 1, $24.07 in Year 2) than in medical practices. CONCLUSIONS: Our two-year trial's findings reinforced the evidence to support SLV-I as a potentially favorable system to increase childhood influenza vaccination rates in a cost-efficient way. Increased efficiencies in SLV-I are needed for a sustainable and scalable SLV-I program.
RCT Entities:
BACKGROUND: School-located vaccination against influenza (SLV-I) has the potential to improve current suboptimal influenza immunization coverage for U.S. school-aged children. However, little is known about SLV-I's cost-effectiveness. The objective of this study is to establish the cost-effectiveness of SLV-I based on a two-year community-based randomized controlled trial (Year 1: 2009-2010 vaccination season, an unusual H1N1 pandemic influenza season, and Year 2: 2010-2011, a more typical influenza season). METHODS: We performed a cost-effectiveness analysis on a two-year randomized controlled trial of a Western New York SLV-I program. SLV-I clinics were offered in 21 intervention elementary schools (Year 1 n = 9,027; Year 2 n = 9,145 children) with standard-of-care (no SLV-I) in control schools (Year 1 n = 4,534 (10 schools); Year 2 n = 4,796 children (11 schools)). We estimated the cost-per-vaccinated child, by dividing the incremental cost of the intervention by the incremental effectiveness (i.e., the number of additionally vaccinated students in intervention schools compared to control schools). RESULTS: In Years 1 and 2, respectively, the effectiveness measure (proportion of children vaccinated) was 11.2 and 12.0 percentage points higher in intervention (40.7 % and 40.4 %) than control schools. In year 2, the cost-per-vaccinated child excluding vaccine purchase ($59.88 in 2010 US $) consisted of three component costs: (A) the school costs ($8.25); (B) the project coordination costs ($32.33); and (C) the vendor costs excluding vaccine purchase ($16.68), summed through Monte Carlo simulation. Compared to Year 1, the two component costs (A) and (C) decreased, while the component cost (B) increased in Year 2. The cost-per-vaccinated child, excluding vaccine purchase, was $59.73 (Year 1) and $59.88 (Year 2, statistically indistinguishable from Year 1), higher than the published cost of providing influenza vaccination in medical practices ($39.54). However, taking indirect costs (e.g., averted parental costs to visit medical practices) into account, vaccination was less costly in SLV-I ($23.96 in Year 1, $24.07 in Year 2) than in medical practices. CONCLUSIONS: Our two-year trial's findings reinforced the evidence to support SLV-I as a potentially favorable system to increase childhood influenza vaccination rates in a cost-efficient way. Increased efficiencies in SLV-I are needed for a sustainable and scalable SLV-I program.
Authors: Byung-Kwang Yoo; Megumi Kasajima; Charles E Phelps; Kevin Fiscella; Nancy M Bennett; Peter G Szilagyi Journal: Am J Prev Med Date: 2011-01 Impact factor: 5.043
Authors: Peter G Szilagyi; Janet R Serwint; Sharon G Humiston; Cynthia M Rand; Stanley Schaffer; Phyllis Vincelli; Nui Dhepyasuwan; Aaron Blumkin; Christina Albertin; C Robinette Curtis Journal: Acad Pediatr Date: 2015 Mar-Apr Impact factor: 3.107
Authors: Byung-Kwang Yoo; Margaret L Holland; Jay Bhattacharya; Charles E Phelps; Peter G Szilagyi Journal: Health Serv Res Date: 2010-10 Impact factor: 3.402
Authors: Paul V Effler; Carl Chu; Howard He; Kate Gaynor; Steve Sakamoto; Marcia Nagao; Lisa Mendez; Sarah Y Park Journal: Emerg Infect Dis Date: 2010-02 Impact factor: 6.883
Authors: Byung-Kwang Yoo; Peter G Szilagyi; Stanley J Schaffer; Sharon G Humiston; Cynthia M Rand; Christina S Albertin; Phyllis Vincelli; Aaron K Blumkin; Laura P Shone; Margaret S Coleman Journal: Pediatrics Date: 2009-12 Impact factor: 7.124
Authors: Byung-Kwang Yoo; Megumi Kasajima; Kevin Fiscella; Nancy M Bennett; Charles E Phelps; Peter G Szilagyi Journal: Am J Public Health Date: 2009-10 Impact factor: 9.308
Authors: Pratha Sah; Jan Medlock; Meagan C Fitzpatrick; Burton H Singer; Alison P Galvani Journal: Proc Natl Acad Sci U S A Date: 2018-04-30 Impact factor: 11.205