Cost effectiveness of school-located influenza vaccination programs for elementary and secondary school children

Byung Kwang Yoo, Stanley J. Schaffer, Sharon G. Humiston, Cynthia M. Rand, Nicolas P.N. Goldstein, Christina S. Albertin, Cathleen Concannon, Peter G. Szilagyi

Research output: Contribution to journalArticle

Abstract

Background: Studies have noted variations in the cost-effectiveness of school-located influenza vaccination (SLIV), but little is known about how SLIV's cost-effectiveness may vary by targeted age group (e.g., elementary or secondary school students), or vaccine consent process (paper-based or web-based). Further, SLIV's cost-effectiveness may be impacted by its spillover effect on practice-based vaccination; prior studies have not addressed this issue. Methods: We performed a cost-effectiveness analysis on two SLIV programs in upstate New York in 2015-2016: (a) elementary school SLIV using a stepped wedge design with schools as clusters (24 suburban and 18 urban schools) and (b) secondary school SLIV using a cluster randomized trial (16 suburban and 4 urban schools). The cost-per-additionally-vaccinated child (i.e., incremental cost-effectiveness ratio (ICER)) was estimated by dividing the incremental SLIV intervention cost by the incremental effectiveness (i.e., the additional number of vaccinated students in intervention schools compared to control schools). We performed deterministic analyses, one-way sensitivity analyses, and probabilistic analyses. Results: The overall effectiveness measure (proportion of children vaccinated) was 5.7 and 5.5 percentage points higher, respectively, in intervention elementary (52.8%) and secondary schools (48.2%) than grade-matched control schools. SLIV programs vaccinated a small proportion of children in intervention elementary (5.2%) and secondary schools (2.5%). In elementary and secondary schools, the ICER excluding vaccine purchase was $85.71 and $86.51 per-additionally-vaccinated-child, respectively. When additionally accounting for observed spillover impact on practice-based vaccination, the ICER decreased to $80.53 in elementary schools - decreasing substantially in secondary schools. (to $53.40). These estimates were higher than the published practice-based vaccination cost (median = $25.50, mean = $45.48). Also, these estimates were higher than our 2009-2011 urban SLIV program mean costs ($65) due to additional costs for use of a new web-based consent system ($12.97 per-additionally-vaccinated-child) and higher project coordination costs in 2015-2016. One-way sensitivity analyses showed that ICER estimates were most sensitive to the SLIV effectiveness. Conclusions: SLIV raises vaccination rates and may increase practice-based vaccination in primary care practices. While these SLIV programs are effective, to be as cost-effective as practice-based vaccination our SLIV programs would need to vaccinate more students and/or lower the costs for consent systems and project coordination. Trial Registration: ClinicalTrials.gov NCT02227186 (August 25, 2014), updated NCT03137667 (May 2, 2017).

Original languageEnglish (US)
Article number407
JournalBMC Health Services Research
Volume19
Issue number1
DOIs
StatePublished - Jun 24 2019

Fingerprint

Human Influenza
Cost-Benefit Analysis
Vaccination
Costs and Cost Analysis
Students
Vaccines

Keywords

  • Adolescents
  • Cost-effectiveness analysis
  • Incremental cost-effectiveness ratio
  • Influenza vaccination
  • School-age children
  • School-located vaccination program
  • Web-based consent form system

ASJC Scopus subject areas

  • Health Policy

Cite this

Yoo, B. K., Schaffer, S. J., Humiston, S. G., Rand, C. M., Goldstein, N. P. N., Albertin, C. S., ... Szilagyi, P. G. (2019). Cost effectiveness of school-located influenza vaccination programs for elementary and secondary school children. BMC Health Services Research, 19(1), [407]. https://doi.org/10.1186/s12913-019-4228-5

Cost effectiveness of school-located influenza vaccination programs for elementary and secondary school children. / Yoo, Byung Kwang; Schaffer, Stanley J.; Humiston, Sharon G.; Rand, Cynthia M.; Goldstein, Nicolas P.N.; Albertin, Christina S.; Concannon, Cathleen; Szilagyi, Peter G.

In: BMC Health Services Research, Vol. 19, No. 1, 407, 24.06.2019.

Research output: Contribution to journalArticle

Yoo, BK, Schaffer, SJ, Humiston, SG, Rand, CM, Goldstein, NPN, Albertin, CS, Concannon, C & Szilagyi, PG 2019, 'Cost effectiveness of school-located influenza vaccination programs for elementary and secondary school children', BMC Health Services Research, vol. 19, no. 1, 407. https://doi.org/10.1186/s12913-019-4228-5
Yoo, Byung Kwang ; Schaffer, Stanley J. ; Humiston, Sharon G. ; Rand, Cynthia M. ; Goldstein, Nicolas P.N. ; Albertin, Christina S. ; Concannon, Cathleen ; Szilagyi, Peter G. / Cost effectiveness of school-located influenza vaccination programs for elementary and secondary school children. In: BMC Health Services Research. 2019 ; Vol. 19, No. 1.
@article{3466636e34a14cb883d7ae4424bdcecf,
title = "Cost effectiveness of school-located influenza vaccination programs for elementary and secondary school children",
abstract = "Background: Studies have noted variations in the cost-effectiveness of school-located influenza vaccination (SLIV), but little is known about how SLIV's cost-effectiveness may vary by targeted age group (e.g., elementary or secondary school students), or vaccine consent process (paper-based or web-based). Further, SLIV's cost-effectiveness may be impacted by its spillover effect on practice-based vaccination; prior studies have not addressed this issue. Methods: We performed a cost-effectiveness analysis on two SLIV programs in upstate New York in 2015-2016: (a) elementary school SLIV using a stepped wedge design with schools as clusters (24 suburban and 18 urban schools) and (b) secondary school SLIV using a cluster randomized trial (16 suburban and 4 urban schools). The cost-per-additionally-vaccinated child (i.e., incremental cost-effectiveness ratio (ICER)) was estimated by dividing the incremental SLIV intervention cost by the incremental effectiveness (i.e., the additional number of vaccinated students in intervention schools compared to control schools). We performed deterministic analyses, one-way sensitivity analyses, and probabilistic analyses. Results: The overall effectiveness measure (proportion of children vaccinated) was 5.7 and 5.5 percentage points higher, respectively, in intervention elementary (52.8{\%}) and secondary schools (48.2{\%}) than grade-matched control schools. SLIV programs vaccinated a small proportion of children in intervention elementary (5.2{\%}) and secondary schools (2.5{\%}). In elementary and secondary schools, the ICER excluding vaccine purchase was $85.71 and $86.51 per-additionally-vaccinated-child, respectively. When additionally accounting for observed spillover impact on practice-based vaccination, the ICER decreased to $80.53 in elementary schools - decreasing substantially in secondary schools. (to $53.40). These estimates were higher than the published practice-based vaccination cost (median = $25.50, mean = $45.48). Also, these estimates were higher than our 2009-2011 urban SLIV program mean costs ($65) due to additional costs for use of a new web-based consent system ($12.97 per-additionally-vaccinated-child) and higher project coordination costs in 2015-2016. One-way sensitivity analyses showed that ICER estimates were most sensitive to the SLIV effectiveness. Conclusions: SLIV raises vaccination rates and may increase practice-based vaccination in primary care practices. While these SLIV programs are effective, to be as cost-effective as practice-based vaccination our SLIV programs would need to vaccinate more students and/or lower the costs for consent systems and project coordination. Trial Registration: ClinicalTrials.gov NCT02227186 (August 25, 2014), updated NCT03137667 (May 2, 2017).",
keywords = "Adolescents, Cost-effectiveness analysis, Incremental cost-effectiveness ratio, Influenza vaccination, School-age children, School-located vaccination program, Web-based consent form system",
author = "Yoo, {Byung Kwang} and Schaffer, {Stanley J.} and Humiston, {Sharon G.} and Rand, {Cynthia M.} and Goldstein, {Nicolas P.N.} and Albertin, {Christina S.} and Cathleen Concannon and Szilagyi, {Peter G.}",
year = "2019",
month = "6",
day = "24",
doi = "10.1186/s12913-019-4228-5",
language = "English (US)",
volume = "19",
journal = "BMC Health Services Research",
issn = "1472-6963",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Cost effectiveness of school-located influenza vaccination programs for elementary and secondary school children

AU - Yoo, Byung Kwang

AU - Schaffer, Stanley J.

AU - Humiston, Sharon G.

AU - Rand, Cynthia M.

AU - Goldstein, Nicolas P.N.

AU - Albertin, Christina S.

AU - Concannon, Cathleen

AU - Szilagyi, Peter G.

PY - 2019/6/24

Y1 - 2019/6/24

N2 - Background: Studies have noted variations in the cost-effectiveness of school-located influenza vaccination (SLIV), but little is known about how SLIV's cost-effectiveness may vary by targeted age group (e.g., elementary or secondary school students), or vaccine consent process (paper-based or web-based). Further, SLIV's cost-effectiveness may be impacted by its spillover effect on practice-based vaccination; prior studies have not addressed this issue. Methods: We performed a cost-effectiveness analysis on two SLIV programs in upstate New York in 2015-2016: (a) elementary school SLIV using a stepped wedge design with schools as clusters (24 suburban and 18 urban schools) and (b) secondary school SLIV using a cluster randomized trial (16 suburban and 4 urban schools). The cost-per-additionally-vaccinated child (i.e., incremental cost-effectiveness ratio (ICER)) was estimated by dividing the incremental SLIV intervention cost by the incremental effectiveness (i.e., the additional number of vaccinated students in intervention schools compared to control schools). We performed deterministic analyses, one-way sensitivity analyses, and probabilistic analyses. Results: The overall effectiveness measure (proportion of children vaccinated) was 5.7 and 5.5 percentage points higher, respectively, in intervention elementary (52.8%) and secondary schools (48.2%) than grade-matched control schools. SLIV programs vaccinated a small proportion of children in intervention elementary (5.2%) and secondary schools (2.5%). In elementary and secondary schools, the ICER excluding vaccine purchase was $85.71 and $86.51 per-additionally-vaccinated-child, respectively. When additionally accounting for observed spillover impact on practice-based vaccination, the ICER decreased to $80.53 in elementary schools - decreasing substantially in secondary schools. (to $53.40). These estimates were higher than the published practice-based vaccination cost (median = $25.50, mean = $45.48). Also, these estimates were higher than our 2009-2011 urban SLIV program mean costs ($65) due to additional costs for use of a new web-based consent system ($12.97 per-additionally-vaccinated-child) and higher project coordination costs in 2015-2016. One-way sensitivity analyses showed that ICER estimates were most sensitive to the SLIV effectiveness. Conclusions: SLIV raises vaccination rates and may increase practice-based vaccination in primary care practices. While these SLIV programs are effective, to be as cost-effective as practice-based vaccination our SLIV programs would need to vaccinate more students and/or lower the costs for consent systems and project coordination. Trial Registration: ClinicalTrials.gov NCT02227186 (August 25, 2014), updated NCT03137667 (May 2, 2017).

AB - Background: Studies have noted variations in the cost-effectiveness of school-located influenza vaccination (SLIV), but little is known about how SLIV's cost-effectiveness may vary by targeted age group (e.g., elementary or secondary school students), or vaccine consent process (paper-based or web-based). Further, SLIV's cost-effectiveness may be impacted by its spillover effect on practice-based vaccination; prior studies have not addressed this issue. Methods: We performed a cost-effectiveness analysis on two SLIV programs in upstate New York in 2015-2016: (a) elementary school SLIV using a stepped wedge design with schools as clusters (24 suburban and 18 urban schools) and (b) secondary school SLIV using a cluster randomized trial (16 suburban and 4 urban schools). The cost-per-additionally-vaccinated child (i.e., incremental cost-effectiveness ratio (ICER)) was estimated by dividing the incremental SLIV intervention cost by the incremental effectiveness (i.e., the additional number of vaccinated students in intervention schools compared to control schools). We performed deterministic analyses, one-way sensitivity analyses, and probabilistic analyses. Results: The overall effectiveness measure (proportion of children vaccinated) was 5.7 and 5.5 percentage points higher, respectively, in intervention elementary (52.8%) and secondary schools (48.2%) than grade-matched control schools. SLIV programs vaccinated a small proportion of children in intervention elementary (5.2%) and secondary schools (2.5%). In elementary and secondary schools, the ICER excluding vaccine purchase was $85.71 and $86.51 per-additionally-vaccinated-child, respectively. When additionally accounting for observed spillover impact on practice-based vaccination, the ICER decreased to $80.53 in elementary schools - decreasing substantially in secondary schools. (to $53.40). These estimates were higher than the published practice-based vaccination cost (median = $25.50, mean = $45.48). Also, these estimates were higher than our 2009-2011 urban SLIV program mean costs ($65) due to additional costs for use of a new web-based consent system ($12.97 per-additionally-vaccinated-child) and higher project coordination costs in 2015-2016. One-way sensitivity analyses showed that ICER estimates were most sensitive to the SLIV effectiveness. Conclusions: SLIV raises vaccination rates and may increase practice-based vaccination in primary care practices. While these SLIV programs are effective, to be as cost-effective as practice-based vaccination our SLIV programs would need to vaccinate more students and/or lower the costs for consent systems and project coordination. Trial Registration: ClinicalTrials.gov NCT02227186 (August 25, 2014), updated NCT03137667 (May 2, 2017).

KW - Adolescents

KW - Cost-effectiveness analysis

KW - Incremental cost-effectiveness ratio

KW - Influenza vaccination

KW - School-age children

KW - School-located vaccination program

KW - Web-based consent form system

UR - http://www.scopus.com/inward/record.url?scp=85068139272&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068139272&partnerID=8YFLogxK

U2 - 10.1186/s12913-019-4228-5

DO - 10.1186/s12913-019-4228-5

M3 - Article

VL - 19

JO - BMC Health Services Research

JF - BMC Health Services Research

SN - 1472-6963

IS - 1

M1 - 407

ER -