Economic Evaluation of Standing Order Programs for Pneumococcal Vaccination of Hospitalized Elderly Patients

Department of Family Medicine, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15232, USA.
Infection Control and Hospital Epidemiology (Impact Factor: 4.18). 05/2008; 29(5):385-94. DOI: 10.1086/587155
Source: PubMed


Standing order programs (SOPs), which allow for vaccination without an individual physician order, are the most effective mechanism to achieve high vaccination rates. Among the suggested settings for the utilization of SOPs are hospital inpatient units, because they provide care for those most likely to benefit from vaccination. The cost-effectiveness of this approach for elderly hospitalized persons is unknown. The purpose of this study was to estimate the cost-effectiveness of SOPs for pneumococcal polysaccharide vaccine (PPV) vaccination for patients 65 years of age or older in 2 types of hospital.
In 2004, a 1,094-bed tertiary care hospital implemented a pharmacy-based SOP for PPV, and a 225-bed community hospital implemented a nursing-based SOP for PPV. Newly admitted patients 65 years of age or older were screened for PPV eligibility and then offered PPV. Vaccination rates before and after initiation of SOPs in the United States, incidence rates of invasive pneumococcal disease in the United States, and US economic data were the bases of the cost-effectiveness analyses. One-way and multivariate sensitivity analyses were conducted.
PPV vaccination rates increased 30.5% in the tertiary care hospital and 15.3% in the community hospital. In the base-case cost-effectiveness analysis, using a societal perspective, we found that both pharmacy-based and nursing-based SOPs cost less than $10,000 per quality-adjusted life-year gained, with program costs (pharmacy-based SOPs cost $4.16 per patient screened, and nursing-based SOPs cost $4.60 per patient screened) and vaccine costs ($18.33 per dose) partially offset by potential savings from cases of invasive pneumococcal disease avoided ($12,436 per case). Sensitivity analyses showed SOPs for PPV vaccination to be cost-effective, compared with PPV vaccination without SOPs, unless the improvement in vaccination rate was less than 8%.
SOPs do increase PPV vaccination rates in hospitalized elderly patients and are economically favorable, compared with PPV vaccination rates without SOPs.

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Available from: Chyongchiou Jeng (C.J.) Lin, Oct 02, 2015
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    • "creased length of opportunity for vaccination may lead to increased PPV vaccination during long stays . Interventions to improve inpatient PPV vaccination have been success - ful independent of length of stay and similar to ambulatory care settings include standing orders , and patient and provider education and reminders ( Clancy et al . , 1992 ; Middleton et al . , 2008 ; Thomas et al . , 2005 ) . PPV interventions targeted towards admission and discharge processes may help reach unvaccinated elderly with short stays . Vaccination rates prior to 2009 were higher for elderly over the age of 75 and individuals with lower household median income ( Table 1 ) . This finding may be due to advancing age being"
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    ABSTRACT: Many elderly remain unvaccinated against invasive pneumococcal disease yet frequently visit acute care providers where they have an opportunity to receive the pneumococcal vaccine. We describe factors associated with pneumococcal vaccination in adults aged 65years and older during visits to acute care providers. The study included all elderly aged 65years of age and older enrolled in a health insurance registry in a large Canadian city in 2009. Pneumococcal vaccination status was determined using a vaccination administrative database. Unvaccinated elderly were linked to ambulatory and inpatient care databases to determine acute care visits. Logistic regression was used to determine odds ratios for vaccination during a first visit to an acute care provider in 2009. Of 53,249 unvaccinated elderly, 23,574 presented to at least one acute care provider in 2009. Acute care visits were significantly associated with receipt of pneumococcal vaccine (11.0% vs. 7.8%, risk adjusted odds ratio [OR]=1.53; 95% confidence interval [CI]=1.44,1.62), particularly ambulatory care visits during influenza season (OR=4.36; 95% CI=2.86,6.66) and inpatient visits with lengths of stay >14days (OR=7.71, 95% CI=4.41,13.47). Acute care visits were associated with greater pneumococcal vaccine uptake for the elderly during the annual influenza season and long hospital stays.
    Preventive Medicine 11/2013; 62. DOI:10.1016/j.ypmed.2013.11.009 · 3.09 Impact Factor
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    • "For example, data from a recent study reveal that while most nursing home residents (about 80%) currenty receive anti-influenza vaccination, less than one third are instead vaccinated against pneumococcus [52]. To achieve higher vaccination rates, the use of Standing Order Program (allowing for vaccination without an individual physician's order) has even been proposed as being the most effective and economically favourable strategy to implement preventive interventions [53]. However, before considering the systematic implementation of an intervention like this (especially given the size of the target population) more robust data are needed. "
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    ABSTRACT: Among the most burdensome clinical conditions occurring in older persons, respiratory infections are particularly relevant. In fact, the onset of pneumonias is associated with a significant worsening of the individual's global health status and significant increase of healthcare costs. The clinical and economical negative consequences of pneumonia may be particularly evident among the frailest groups of elders, in particular those living in nursing home. Nevertheless, specific research on incidence and economical effects of pneumonia in nursing homes residents is still scarce. In the present article, we present the rationale, the design and the methods of the "Incidence of pNeumonia and related ConseqUences in nursing home Resident (INCUR) study, specifically aimed at filling some of the gaps currently present in the field.Methods/design: INCUR is an observational longitudinal study recruiting 800 residents across 13 randomly selected nursing homes in France. Multidimensional evaluations of participants are conducted at the baseline, mid-term (at 6 months), and end of the study (at 12 months) visits in order to measure and follow-up their physical function, nutrition, cognition, depression, quality of life, and healthcare costs. Incident pneumonia as well as the onset/recurrence of other major health-related events are monitored during the study follow-up. The INCUR study will provide valuable information about older persons living in nursing homes. Results from INCUR study may constitute the basis for the development of future preventive campaigns against pneumonia and its consequences.
    BMC Public Health 09/2013; 13(1):861. DOI:10.1186/1471-2458-13-861 · 2.26 Impact Factor
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    • "Introduction of SOPs has been shown to increase influenza and pneumococcal vaccination rates in inpatient settings [9,10]. In outpatient settings, SOPs improved influenza vaccination rates 27% in a general elderly patient population [11] and among cardiovascular patients attending a lipid clinic [12]. "
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    ABSTRACT: Standing orders programs (SOPs) allow non-physician medical staff to assess eligibility and administer vaccines without a specific physician's order. SOPs increase vaccination rates but are underutilized. In 2009, correlates of SOPs use for influenza vaccine and pneumococcal polysaccharide vaccination (PPV) were assessed in a nationally representative, stratified random sample of U.S. physicians (n = 880) in family and internal medicine who provided office immunization. The response rate was 67%. Physicians reporting no SOPs, only influenza SOPs, and joint influenza and PPV SOPs were compared using multinomial and logistic regression models to examine individual and practice-level correlates. 23% reported using SOPs consistently for both influenza vaccine and PPV, and 20% for influenza vaccination only, with the remainder not using SOPs. Practice-level factors that distinguished practices with joint influenza-PPV SOPs included perceived practice openness to change, strong practice teamwork, access to an electronic medical record, presence of an immunization champion in the practice, and access to nurse/physician assistant staff as opposed to medical assistants alone. Physicians in practices with SOPs for both vaccines reported greater awareness of ACIP recommendations and/or Medicare regulations and were more likely to agree that SOPs are an effective way to boost vaccination coverage. However, implementation of both influenza and PPV SOPs was also associated with a variety of practice-level factors, including teamwork, the presence of an immunization champion, and greater availability of clinical assistants with advanced training. Practice-level factors are critical for the adoption of more complex SOPs, such as joint SOPs for influenza and PPV.
    BMC Family Practice 03/2012; 13(1):22. DOI:10.1186/1471-2296-13-22 · 1.67 Impact Factor
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