This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Jane E. Sisk, PhD; Alan J. Moskowitz, MD; William Whang; Jean D. Lin, MD, MPH; David S. Fedson, MD; A. Marshall McBean, MD, MSc; Joseph F. Plouffe, MD; Martin S. Cetron, MD; Jay C. Butler, MD

JAMA. 1997;278(16):1333-1339.

Abstract
Context.
—Clinical, epidemiologic, and policy considerations support updating the cost-effectiveness of pneumococcal vaccination for elderly people and targeting the evaluation only to prevention of pneumococcal bacteremia.

Objective.
—To assess the implications for medical costs and health effects of vaccination against pneumococcal bacteremia in elderly people.

Design.
—Cost-effectiveness analysis of pneumococcal vaccination compared with no vaccination, from a societal perspective.

Setting and Participants.
—The elderly population aged 65 years and older in the United States in 3 geographic areas: metropolitan Atlanta, Ga; Franklin County, Ohio; and Monroe County, New York.

Main Outcome Measures.
—Incremental medical costs and health effects, expressed in quality-adjusted life-years per person vaccinated.

Results.
—Vaccination was cost saving, ie, it both reduced medical expenses and improved health, for all age groups and geographic areas analyzed in the base case. For people aged 65 years and older, vaccination saved $8.27 and gained 1.21 quality-adjusted days of life per person vaccinated. Vaccination of the 23 million elderly people unvaccinated in 1993 would have gained about 78 000 years of healthy life and saved $194 million. In univariate sensitivity analysis, the results remained cost saving except for doubling vaccination costs, including future medical costs of survivors, and lowering vaccination effectiveness. With assumptions most unfavorable to vaccination, cost per quality-adjusted life-year ranged from $35822 for ages 65 to 74 years to $598487 for ages 85 years and older. In probabilistic sensitivity analysis, probability intervals were more narrow, with less than 5% probability that the ratio for ages 85 years and older would exceed $100000.

Conclusions.
—Pneumococcal vaccination saves costs in the prevention of bacteremia alone and is greatly underused among the elderly population, on both health and economic grounds. These results support recent recommendations of the Advisory Committee on Immunization Practices and public and private efforts under way to improve vaccination rates.

Author Affiliations
From Columbia University School of Public Health, Division of Health Policy and Management, New York, NY (Drs Sisk and Moskowitz and Mr Whang); State University of New York at Stony Brook (Dr Lin); Pasteur Merieux MSD, Lyon, France (Dr Fedson); University of Minnesota, Minneapolis, (Dr McBean); Ohio State University, Columbus (Dr Plouffe); and Centers for Disease Control and Prevention, Atlanta, Ga (Drs Cetron and Butler).

Dr Fedson is employed by Pasteur Merieux MSD. Columbia University has received unrestricted contributions from Pasteur Merieux MSD and Merck Vaccine Division, West Point, Pa.

Footnotes
Corresponding author: Jane E. Sisk, PhD, Columbia University School of Public Health, 600 W168th St, Sixth Floor, New York, NY 10032 (e-mail: jes19@columbia.edu).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Cost-effectiveness analysis of influenza and pneumococcal vaccination for Hong Kong elderly in long-term care facilities
You et al.
J. Epidemiol. Community Health 2009;63:906-911.
ABSTRACT | FULL TEXT  

Extracorporeal Life Support: Utilization, Cost, Controversy, and Ethics of Trying to Save Lives
Crow et al.
SEMIN CARDIOTHORAC VASC ANESTH 2009;13:183-191.
ABSTRACT  

Effect of Pneumococcal Vaccination in Hospitalized Adults With Community-Acquired Pneumonia
Johnstone et al.
Arch Intern Med 2007;167:1938-1943.
ABSTRACT | FULL TEXT  

Cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults.
Hornberger and Robertus
ANN INTERN MED 2006;145:317-325.
ABSTRACT | FULL TEXT  

Comparing cost/utility of giving an aromatase inhibitor as monotherapy for 5 years versus sequential administration following 2-3 or 5 years of tamoxifen as adjuvant treatment for postmenopausal breast cancer
Lonning
Ann Oncol 2006;17:217-225.
ABSTRACT | FULL TEXT  

Guidelines for the management of adult lower respiratory tract infections
Woodhead et al.
Eur Respir J 2005;26:1138-1180.
ABSTRACT | FULL TEXT  

Medicare and Cost-Effectiveness Analysis
Neumann et al.
NEJM 2005;353:1516-1522.
FULL TEXT  

Explaining Trends in Hospitalizations for Pneumonia and Influenza in the Elderly
Hebert et al.
Med Care Res Rev 2005;62:560-582.
ABSTRACT  

Cost-Effectiveness of Full Medicare Coverage of Angiotensin-Converting Enzyme Inhibitors for Beneficiaries with Diabetes
Rosen et al.
ANN INTERN MED 2005;143:89-99.
ABSTRACT | FULL TEXT  

An economic analysis of a pneumococcal vaccine programme in people aged over 64 years in a developed country setting
Mangtani et al.
Int J Epidemiol 2005;34:565-574.
ABSTRACT | FULL TEXT  

Pharmacists' role in increasing pneumococcal and influenza vaccination
Sokos
Am J Health Syst Pharm 2005;62:367-377.
ABSTRACT | FULL TEXT  

A census of economic evaluations in health promotion
Rush et al.
Health Educ Res 2004;19:707-719.
ABSTRACT | FULL TEXT  

Inpatient Computer-Based Standing Orders vs Physician Reminders to Increase Influenza and Pneumococcal Vaccination Rates: A Randomized Trial
Dexter et al.
JAMA 2004;292:2366-2371.
ABSTRACT | FULL TEXT  

Pneumococcal Bacteremia: Lessons Learned, Yet More to Learn
Maki
Mayo Clin Proc. 2004;79:599-603.
 

Preventive Health Care in the Elderly Population: A Guide for Practicing Physicians
Takahashi et al.
Mayo Clin Proc. 2004;79:416-427.
ABSTRACT  

Pneumococcal Vaccination in Older Adults
Hirschmann et al.
NEJM 2003;349:712-714.
FULL TEXT  

Cost-Effectiveness of Vaccination against Invasive Pneumococcal Disease among People 50 through 64 Years of Age: Role of Comorbid Conditions and Race
Sisk et al.
ANN INTERN MED 2003;138:960-968.
ABSTRACT | FULL TEXT  

Effectiveness of Pneumococcal Polysaccharide Vaccine in Older Adults
Jackson et al.
NEJM 2003;348:1747-1755.
ABSTRACT | FULL TEXT  

Pneumococcal Vaccination and Revaccination of Older Adults
Artz et al.
Clin. Microbiol. Rev. 2003;16:308-318.
ABSTRACT | FULL TEXT  

Racial/Ethnic Differences in Adult Vaccination Among Individuals With Diabetes
Egede and Zheng
AJPH 2003;93:324-329.
ABSTRACT | FULL TEXT  

Failure to Vaccinate Medicare Inpatients: A Missed Opportunity
Bratzler et al.
Arch Intern Med 2002;162:2349-2356.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of the Pneumococcal Vaccine in Healthy Younger Adults
Pepper and Owens
Med Decis Making 2002;22:S45-S57.
ABSTRACT  

Cost-Benefit Analysis of a New HEDIS Performance Measure for Pneumococcal Vaccination
Ahmed et al.
Med Decis Making 2002;22:S58-S66.
ABSTRACT  

Generalist and Subspecialist Physicians' Knowledge, Attitudes, and Practices Regarding Influenza and Pneumococcal Vaccinations for Elderly and Other High-Risk Patients: A Nationwide Survey
Nichol and Zimmerman
Arch Intern Med 2001;161:2702-2708.
ABSTRACT | FULL TEXT  

Outbreak of Pneumococcal Pneumonia Among Unvaccinated Residents of a Nursing Home--New Jersey, April 2001
JAMA 2001;286:1570-1571.
FULL TEXT  

A Computerized Reminder System to Increase the Use of Preventive Care for Hospitalized Patients
Dexter et al.
NEJM 2001;345:965-970.
ABSTRACT | FULL TEXT  

Pneumococcal Vaccination in Adults
Artz et al.
JAMA 2001;286:166-167.
FULL TEXT  

Pneumococcal vaccination: current and future issues
Ortqvist
Eur Respir J 2001;18:184-195.
ABSTRACT | FULL TEXT  

Guidelines for the Management of Adults with Community-acquired Pneumonia . Diagnosis, Assessment of Severity, Antimicrobial Therapy, and Prevention
Niederman et al.
Am. J. Respir. Crit. Care Med. 2001;163:1730-1754.
FULL TEXT  

Prevention of influenza and pneumococcal pneumonia in Canadian long-term care facilities: How are we doing?
Stevenson et al.
CMAJ 2001;164:1413-1419.
ABSTRACT | FULL TEXT  

Epidemiology of Invasive Streptococcus pneumoniae Infections in the United States, 1995-1998: Opportunities for Prevention in the Conjugate Vaccine Era
Robinson et al.
JAMA 2001;285:1729-1735.
ABSTRACT | FULL TEXT  

Cost-effectiveness of Combined Outreach for the Pneumococcal and Influenza Vaccines
Weaver et al.
Arch Intern Med 2001;161:111-120.
ABSTRACT | FULL TEXT  

Managing Antibiotic Resistance
Wenzel and Edmond
NEJM 2000;343:1961-1963.
FULL TEXT  

The Drug-Resistant Pneumococcus: Clinical Relevance, Therapy, and Prevention
Harwell and Brown
Chest 2000;117:530-541.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of Adding an Electron-Beam Boost to Tangential Radiation Therapy in Patients With Negative Margins After Conservative Surgery for Early-Stage Breast Cancer
Hayman et al.
JCO 2000;18:287-287.
ABSTRACT | FULL TEXT  

The Health and Economic Benefits Associated With Pneumococcal Vaccination of Elderly Persons With Chronic Lung Disease
Nichol et al.
Arch Intern Med 1999;159:2437-2442.
ABSTRACT | FULL TEXT  

Risk Factors for Pneumonia and Other Lower Respiratory Tract Infections in Elderly Residents of Long-term Care Facilities
Loeb et al.
Arch Intern Med 1999;159:2058-2064.
ABSTRACT | FULL TEXT  

Emerging Infectious Diseases: Public Health Issues for the 21st Century
Binder et al.
Science 1999;284:1311-1313.
ABSTRACT | FULL TEXT  

The Cost Effectiveness of Strategies for the Treatment of Intestinal Parasites in Immigrants
Muennig et al.
NEJM 1999;340:773-779.
ABSTRACT | FULL TEXT  

Revaccination of High-Risk Adults With Pneumococcal Polysaccharide Vaccine
Nichol
JAMA 1999;281:280-281.
FULL TEXT  

Recent advances: Pulmonary medicine
Roche
BMJ 1999;318:171-176.
FULL TEXT  

The place of pneumococcal vaccination
DTB 1998;36:73-76.
ABSTRACT | FULL TEXT  

An Outbreak of Multidrug-Resistant Pneumococcal Pneumonia and Bacteremia among Unvaccinated Nursing Home Residents
Nuorti et al.
NEJM 1998;338:1861-1868.
ABSTRACT | FULL TEXT  

PNEUMOCOCCAL VACCINATION SAVES COSTS AND LIVES
JWatch General 1997;1997:6-6.
FULL TEXT  

Living Longer, Aging Better: Aging Research Comes of Age
Wetle
JAMA 1997;278:1376-1377.
ABSTRACT