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

Donald B. Middleton , MD, Chyongchiou J. Lin , PhD, Kenneth J. Smith , MD, MS, Richard K. Zimmerman , MD, MPH, Mary Patricia Nowalk , PhD, RD, Mark S. Roberts , MD, MPP and Dwight E. Fox , DMD
Infection Control and Hospital Epidemiology
Vol. 29, No. 5 (May 2008), pp. 385-394
DOI: 10.1086/587155
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Page Count: 10
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Economic Evaluation of Standing Order Programs for Pneumococcal Vaccination of Hospitalized Elderly Patients
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Background.  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. Methods.  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. Results.  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%. Conclusion.  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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