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Hong K, Leidner AJ, Tsai Y, Tang Z, Cho BH, Stokley S. Costs of Interventions to Increase Vaccination Coverage Among Children in the United States: A Systematic Review. Acad Pediatr 2021; 21:S67-S77. [PMID: 33958096 PMCID: PMC9998236 DOI: 10.1016/j.acap.2020.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/15/2020] [Accepted: 11/08/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The Community Preventive Services Task Force (CPSTF) has recommended several interventions that have been demonstrated to be effective at increasing vaccination coverage. OBJECTIVE Conduct a systematic review to examine the costs of interventions designed to increase vaccination coverage among children and adolescents in the United States. DATA SOURCES PubMed, EconLit, Embase, and Cochrane. STUDY ELIGIBILITY, PARTICIPANTS, AND INTERVENTIONS Peer-reviewed articles from January 1, 2009 to August 31, 2019. APPRAISAL AND SYNTHESIS METHODS Studies were identified with systematic searches of the literature, reviewed for inclusion criteria, abstracted for data on intervention, target population, costs, and risk of bias. Cost measures were reported as costs per child in the target population, costs per vaccinated child, incremental costs per vaccinated child, and costs per vaccine dose administered. Results were stratified by intervention type, vaccine, and age group. RESULTS Thirty-seven studies were identified for full-text review. Across all interventions and age groups, the cost per child ranged from $0.10 to $537.38, and the incremental cost per vaccinated child ranged from $6.52 to $5,098.57. Provider assessment and feedback interventions had the lowest (median) cost per child ($0.17) and a healthcare system-based combined intervention with multiple components had the lowest (median) incremental cost per vaccinated child ($26.65). A community-based combined intervention with multiple components had the highest median cost per child ($537.38) and the highest median incremental cost per vaccinated child ($5,098.57). LIMITATIONS A small number of included intervention types and inconsistent cost definition. CONCLUSIONS There is substantial variability in the costs of CPSTF-recommended interventions.
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Affiliation(s)
- Kai Hong
- Immunization Service Division, National Center for Immunization and Respiratory Diseases (NCIRD) (K Hong, AJ Leidner, Y Tsai, B-H Cho, and S Stokley), Centers for Disease Control and Prevention (CDC), Atlanta, Ga.
| | - Andrew J Leidner
- Immunization Service Division, National Center for Immunization and Respiratory Diseases (NCIRD) (K Hong, AJ Leidner, Y Tsai, B-H Cho, and S Stokley), Centers for Disease Control and Prevention (CDC), Atlanta, Ga
| | - Yuping Tsai
- Immunization Service Division, National Center for Immunization and Respiratory Diseases (NCIRD) (K Hong, AJ Leidner, Y Tsai, B-H Cho, and S Stokley), Centers for Disease Control and Prevention (CDC), Atlanta, Ga
| | - Zhaoli Tang
- Berry Technology Solutions (Z Tang), Atlanta, Ga
| | - Bo-Hyun Cho
- Immunization Service Division, National Center for Immunization and Respiratory Diseases (NCIRD) (K Hong, AJ Leidner, Y Tsai, B-H Cho, and S Stokley), Centers for Disease Control and Prevention (CDC), Atlanta, Ga
| | - Shannon Stokley
- Immunization Service Division, National Center for Immunization and Respiratory Diseases (NCIRD) (K Hong, AJ Leidner, Y Tsai, B-H Cho, and S Stokley), Centers for Disease Control and Prevention (CDC), Atlanta, Ga
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Kempe A, Saville AW, Albertin C, Helmkamp L, Zhou X, Vangela S, Dickinson LM, Tseng CH, Campbell JD, Whittington M, Gurfinkel D, Roth H, Hoefer D, Szilagyi P. Centralized Reminder/Recall to Increase Influenza Vaccination Rates: A Two-State Pragmatic Randomized Trial. Acad Pediatr 2020; 20:374-383. [PMID: 31698085 PMCID: PMC7477488 DOI: 10.1016/j.acap.2019.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Centralized reminder/recall (C-R/R) by health departments using immunization information systems is more effective and cost effective than practice-based approaches for increasing childhood vaccines but has not been studied for influenza vaccination. We assessed effectiveness and cost of C-R/R for increasing childhood influenza vaccination compared with usual care. METHODS Within Colorado (CO) and New York (NY), random samples of primary care practices (pediatric, family medicine, and health center) were selected proportionate to where children are served-65 practices (N = 54,353 children) in CO; 101 practices (N = 65,777) in NY. We conducted 4-arm RCTs per state (1, 2, or 3 autodial reminders vs usual care), with randomization at the patient level within practices from 10/2016 to 1/2017. RESULTS In CO, the maximum absolute difference in receipt of ≥1 influenza vaccine was 1.7% between the 2 R/R group and control (adjusted risk ratio [ARR] of 1.06 [1.01, 1.10]); other R/R arms did not differ significantly. In NY, ARRs for the study arms versus control varied from 1.05 (1.01, 1.10) for 3 R/R to 1.06 (1.01, 1.11) for 1-2 R/R groups and maximum absolute increase in vaccination was 0.6%. In time-to-event analyses, study arm was a significant predictor of vaccination in CO (P = .001) but not in NY. Costs/child randomized to one message were $.17 in CO and $.23 in NY. CONCLUSIONS C-R/R for influenza vaccine using autodial had low-level effects on increasing influenza rates in 2 states. Given the feasibility and low cost of C-R/R in previous trials, its utility for influenza should be re-examined using different modalities.
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Affiliation(s)
- Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, AW Saville, L Helmkamp, LM Dickinson, and D Gurfinkel), Aurora, Colo; Department of Pediatrics, University of Colorado School of Medicine (A Kempe), Aurora, Colo.
| | - Alison W Saville
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, AW Saville, L Helmkamp, LM Dickinson, and D Gurfinkel), Aurora, Colo
| | - Christina Albertin
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles (C Albertin and P Szilagyi), Los Angeles, Calif
| | - Laura Helmkamp
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, AW Saville, L Helmkamp, LM Dickinson, and D Gurfinkel), Aurora, Colo
| | - Xinkai Zhou
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California (X Zhou, S Vangela, and C-H Tseng), Los Angeles, Calif
| | - Sitaram Vangela
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California (X Zhou, S Vangela, and C-H Tseng), Los Angeles, Calif
| | - L Miriam Dickinson
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, AW Saville, L Helmkamp, LM Dickinson, and D Gurfinkel), Aurora, Colo; Department of Family Medicine, University of Colorado School of Medicine (LM Dickinson), Aurora, Colo
| | - Chi-Hong Tseng
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California (X Zhou, S Vangela, and C-H Tseng), Los Angeles, Calif
| | - Jonathan D Campbell
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus (JD Campbell and M Whittington), Aurora, Colo
| | - Melanie Whittington
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus (JD Campbell and M Whittington), Aurora, Colo
| | - Dennis Gurfinkel
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, AW Saville, L Helmkamp, LM Dickinson, and D Gurfinkel), Aurora, Colo
| | - Heather Roth
- Colorado Immunization Information System, Colorado Department of Public Health and Environment (H Roth), Denver, Colo
| | - Dina Hoefer
- New York State Immunization Information System, New York State Department of Health (D Hoefer), Albany, NY
| | - Peter Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles (C Albertin and P Szilagyi), Los Angeles, Calif
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Weinberg GA. Nontraditional Uses of Live Attenuated Influenza Vaccine: School-Located Influenza Vaccination. J Pediatric Infect Dis Soc 2020; 9:S19-S23. [PMID: 32191311 DOI: 10.1093/jpids/piaa007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Immunization against influenza continues to be the best method of preventing influenza infection in children, and additionally, indirectly helping to lower disease in adults, given the role of children as "spreaders" of influenza to the community at large. An increasing evidence base exists for the use of school-located influenza vaccination (SLIV) programs to increase the influenza vaccination rates among children. Live, attenuated influenza vaccine (LAIV) has unique characteristics that make it useful for SLIV programs, including ease of immunization without needles, faster delivery, and in many (but not all) years, good vaccine effectiveness. Reviewed herein are results of selected published trials as well as guidance on planning a successful SLIV program.
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Affiliation(s)
- Geoffrey A Weinberg
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, University of Rochester Golisano Children's Hospital, Rochester, New York, USA
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4
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Cost effectiveness of school-located influenza vaccination programs for elementary and secondary school children. BMC Health Serv Res 2019; 19:407. [PMID: 31234842 PMCID: PMC6591987 DOI: 10.1186/s12913-019-4228-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 06/07/2019] [Indexed: 12/04/2022] Open
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.govNCT02227186 (August 25, 2014), updated NCT03137667 (May 2, 2017). Electronic supplementary material The online version of this article (10.1186/s12913-019-4228-5) contains supplementary material, which is available to authorized users.
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Patel SA, Groom HC, Cho BH, Martin K, Moore R. Billing and Volunteers Substantially Reduced School-Located Influenza Vaccination Costs, 2 Oregon Counties, 2010-2011. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 24:558-566. [DOI: 10.1097/phh.0000000000000710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Szilagyi PG, Schaffer S, Rand CM, Vincelli P, Eagan A, Goldstein NPN, Hightower AD, Younge M, Blumkin A, Albertin CS, Yoo BK, Humiston SG. School-Located Influenza Vaccinations: A Randomized Trial. Pediatrics 2016; 138:peds.2016-1746. [PMID: 27940785 DOI: 10.1542/peds.2016-1746] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Assess impact of offering school-located influenza vaccination (SLIV) clinics using both Web-based and paper consent upon overall influenza vaccination rates among elementary school children. METHODS We conducted a cluster-randomized trial (stratified by suburban/urban districts) in upstate New York in 2014-2015. We randomized 44 elementary schools, selected similar pairs of schools within districts, and allocated schools to SLIV versus usual care (control). Parents of children at SLIV schools were sent information and vaccination consent forms via e-mail, backpack fliers, or both (depending on school preferences) regarding school vaccine clinics. Health department nurses conducted vaccine clinics and billed insurers. For all children registered at SLIV/control schools, we compared receipt of influenza vaccination anywhere (primary outcome). RESULTS The 44 schools served 19 776 eligible children in 2014-2015. Children in SLIV schools had higher influenza vaccination rates than children in control schools county-wide (54.1% vs 47.4%, P < .001) and in suburban (61.9% vs 53.6%, P < .001) and urban schools (43.9% vs 39.2%; P < .001). Multivariate analyses (controlling for age, grade, vaccination in previous season) confirmed bivariate findings. Among parents who consented for SLIV, nearly half of those notified by backpack fliers and four-fifths of those notified by e-mail consented online. In suburban districts, SLIV did not substitute for primary care influenza vaccination. In urban schools, some substitution occurred. CONCLUSIONS SLIV raised seasonal influenza vaccination rates county-wide and in both suburban and urban settings. SLIV did not substitute for primary care vaccinations in suburban settings where pediatricians often preorder influenza vaccine but did substitute somewhat in urban settings.
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Affiliation(s)
- Peter G Szilagyi
- Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, California;
| | - Stanley Schaffer
- Department of Pediatrics, Golisano Children's Hospital, School of Medicine and Dentistry, and
| | - Cynthia M Rand
- Department of Pediatrics, Golisano Children's Hospital, School of Medicine and Dentistry, and
| | - Phyllis Vincelli
- Department of Pediatrics, Golisano Children's Hospital, School of Medicine and Dentistry, and
| | - Ashley Eagan
- Department of Pediatrics, Golisano Children's Hospital, School of Medicine and Dentistry, and
| | - Nicolas P N Goldstein
- Department of Pediatrics, Golisano Children's Hospital, School of Medicine and Dentistry, and
| | - A Dirk Hightower
- Department of Clinical and Social Psychology, Children's Institute Rochester, University of Rochester, Rochester, New York
| | - Mary Younge
- Department of Public Health, Monroe County, New York
| | - Aaron Blumkin
- Department of Pediatrics, Golisano Children's Hospital, School of Medicine and Dentistry, and
| | - Christina S Albertin
- Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, California
| | - Byung-Kwang Yoo
- Department of Public Health Sciences, University of California at Davis, Davis, California; and
| | - Sharon G Humiston
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
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Parents' and staff's support for a childcare agency employee mandatory vaccination policy or agency certification program. Am J Infect Control 2016; 44:799-804. [PMID: 27021508 DOI: 10.1016/j.ajic.2016.01.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 01/13/2016] [Accepted: 01/19/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Vaccine-preventable diseases pose a significant risk to children in childcare. However, few regulations exist regarding childcare staff vaccination. This study aimed to assess support for a childcare agency staff mandatory vaccination policy. METHODS Surveys were distributed to staff and parents at 23 St Louis, Mo, childcare agencies during fall 2014. Staff and parents' support for a mandatory vaccination and/or agency certification program were compared using χ(2) tests. Multivariate logistic regression was conducted using a 2-level nested design and controlling for gender, race, age, and income to determine predictive models for support for a mandatory staff vaccination policy and/or agency certification program. RESULTS Overall, 354 parents and staff participated (response rate, 32%). Most supported a mandatory staff vaccination policy (80.0%; n = 280) or agency certification program (81.2%; n = 285), and there were no differences between parents versus staff. Determinants of support for a mandatory policy included willingness to receive influenza vaccine annually, belief that vaccines are safe and effective, and support for the policy only if there were no costs. CONCLUSIONS There is strong support for some type of childcare agency staff vaccination policy. Implementing such a policy/program should be a collaborative endeavor that addresses vaccine cost and access.
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Tran CH, Brew J, Johnson N, Ryan KA, Martin B, Cornett C, Caron B, Duncan RP, Small PA, Myers PD, Morris JG. Sustainability of school-located influenza vaccination programs in Florida. Vaccine 2016; 34:2737-44. [PMID: 27126875 DOI: 10.1016/j.vaccine.2016.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND School-located influenza vaccination (SLIV) programs are a promising strategy for increasing vaccination coverage among schoolchildren. However, questions of economic sustainability have dampened enthusiasm for this approach in the United States. We evaluated SLIV sustainability of a health department led, county-wide SLIV program in Alachua County, Florida. Based on Alachua's outcome data, we modeled the sustainability of SLIV programs statewide using two different implementation costs and at different vaccination rates, reimbursement amount, and Vaccines for Children (VFC) coverage. METHODS Mass vaccination clinics were conducted at 69 Alachua County schools in 2013 using VFC (for Medicaid and uninsured children) and non-VFC vaccines. Claims were processed after each clinic and submitted to insurance providers for reimbursement ($5 Medicaid and $47.04 from private insurers). We collected programmatic expenditures and volunteer hours to calculate fixed and variable costs for two different implementation costs (with or without in-kind costs included). We project program sustainability for Florida using publicly available county-specific student populations and health insurance enrollment data. RESULTS Approximately 42% (n=12,853) of pre-kindergarten - 12th grade students participated in the SLIV program in Alachua. Of the 13,815 doses provided, 58% (8042) were non-VFC vaccine. Total implementation cost was $14.95/dose or $7.93/dose if "in-kind" costs were not included. The program generated a net surplus of $24,221, despite losing $4.68 on every VFC dose provided to Medicaid and uninsured children. With volunteers, 99% of Florida counties would be sustainable at a 50% vaccination rate and average reimbursement amount of $3.25 VFC and $37 non-VFC. Without volunteers, 69% of counties would be sustainable at 50% vaccination rate if all VFC recipients were on Medicaid and its reimbursement increased from $5 to $10 (amount private practices receive). CONCLUSIONS AND RELEVANCE Key factors that contributed to the sustainability and success of an SLIV program are: targeting privately insured children and reducing administration cost through volunteers. Counties with a high proportion of VFC eligible children may not be sustainable without subsidies at $5 Medicaid reimbursement.
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Affiliation(s)
- Cuc H Tran
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States; Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States
| | - Joe Brew
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States; Florida Department of Health in Alachua County, Gainesville, FL, United States
| | - Nicholas Johnson
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States; Florida Department of Health in Alachua County, Gainesville, FL, United States
| | - Kathleen A Ryan
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States; Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States; College of Medicine, University of Florida, Gainesville, FL, United States
| | - Brittany Martin
- Florida Department of Health in Alachua County, Gainesville, FL, United States
| | - Catherine Cornett
- Florida Department of Health in Alachua County, Gainesville, FL, United States
| | - Brad Caron
- Florida Department of Health in Alachua County, Gainesville, FL, United States
| | - R Paul Duncan
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Parker A Small
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States; Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States; College of Medicine, University of Florida, Gainesville, FL, United States
| | - Paul D Myers
- Florida Department of Health in Alachua County, Gainesville, FL, United States
| | - J Glenn Morris
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States; Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States; College of Medicine, University of Florida, Gainesville, FL, United States.
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Gicquelais RE, Safi H, Butler S, Smith N, Haselow DT. Association of School-Based Influenza Vaccination Clinics and School Absenteeism--Arkansas, 2012-2013. THE JOURNAL OF SCHOOL HEALTH 2016; 86:235-241. [PMID: 26930234 DOI: 10.1111/josh.12372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 06/18/2015] [Accepted: 04/09/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Influenza is a major cause of seasonal viral respiratory illness among school-aged children. Accordingly, the Arkansas Department of Health (ADH) coordinates >800 school-based influenza immunization clinics before each influenza season. We quantified the relationship between student influenza vaccination in Arkansas public schools and school absenteeism during the 2012-2013 influenza season. METHODS The relationship between the percent of students vaccinated in Arkansas public schools during ADH-facilitated clinics and the average daily percent of students absent from school during the 2012-2013 influenza season was quantified using linear regression modeling. The effect of increasing vaccination coverage among students on absentee days in the Arkansas public school system was estimated. RESULTS For every 1% higher vaccination coverage, 0.027% fewer absenteeism days were predicted. Larger school size was associated with higher absenteeism and predicted decreases in absenteeism were larger in magnitude for larger schools compared with smaller schools. Extrapolation of the model showed that a 10% higher vaccination level was associated with a reduction of 16-163 student absentee days per school over a 12-week influenza season. CONCLUSIONS Influenza vaccination is an effective tool to reduce school absenteeism. School-based clinics are a feasible way to target influenza vaccinations to school-aged children.
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Affiliation(s)
| | - Haytham Safi
- Arkansas Department of Health, 4815W Markham St, Little Rock, AR 72205.
| | - Sandra Butler
- Arkansas Department of Health, Little Rock, AR 72205.
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Weinberg GA. A Celebration of the Life and Work of Caroline Breese Hall, MD. J Pediatric Infect Dis Soc 2016; 5:e1-4. [PMID: 26908498 PMCID: PMC7107472 DOI: 10.1093/jpids/piu118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 11/16/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Geoffrey A. Weinberg
- University of Rochester School of Medicine and Dentistry, New York,Corresponding Author:
Geoffrey A. Weinberg, MD, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642. E-mail:
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Jacobson RM, Agunwamba AA, St. Sauver JL, Finney Rutten LJ. The most effective and promising population health strategies to advance human papillomavirus vaccination. Expert Rev Vaccines 2015; 15:257-69. [PMID: 26559567 PMCID: PMC6684098 DOI: 10.1586/14760584.2016.1116947] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 11/03/2015] [Indexed: 01/21/2023]
Abstract
The US is failing to make substantive progress toward improving rates of human papillomavirus vaccine uptake. While the Healthy People 2020 goal for human papillomavirus (HPV) vaccination is 80%, the three-dose completion rate in the US in 2014 for 13- to 17-year-old females is less than 40%, and the rate for males is just above 20%. Experts point to a number of reasons for the poor HPV vaccination rates including parental concerns about safety, necessity, and timing. However, the evidence refuting these concerns is substantial. Efforts focusing on education and communication have not shown promise, but several population health strategies have reminder/recall systems; practice-focused strategies targeting staff, clinicians, and parents; assessment and feedback activities; and school-based HPV vaccination programs.
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Affiliation(s)
- Robert M. Jacobson
- Department of Pediatric and Adolescent Medicine, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Amenah A. Agunwamba
- Department of Health Sciences Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L. St. Sauver
- Department of Health Sciences Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Lila J. Finney Rutten
- Department of Health Sciences Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
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Cost effectiveness analysis of Year 2 of an elementary school-located influenza vaccination program-Results from a randomized controlled trial. BMC Health Serv Res 2015; 15:511. [PMID: 26573461 PMCID: PMC4647510 DOI: 10.1186/s12913-015-1169-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 11/09/2015] [Indexed: 11/10/2022] Open
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) 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.
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Shlay JC, Rodgers S, Lyons J, Romero S, Vogt TM, McCormick EV. Implementing a School-Located Vaccination Program in Denver Public Schools. THE JOURNAL OF SCHOOL HEALTH 2015; 85:536-543. [PMID: 26149309 DOI: 10.1111/josh.12281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 01/09/2015] [Accepted: 02/03/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND School-located vaccination (SLV) offers an opportunity to deliver vaccines to students, particularly those without a primary care provider. METHODS This SLV program offered 2 clinics at each of 20 elementary schools (influenza vaccine) and 3 clinics at each of 7 middle/preschool-eighth-grade schools (adolescent platform plus catch-up vaccines) during the 2009-2010 and 2010-2011 school years. Established programmatic processes for immunization delivery in an outreach setting were used. Billing and vaccine inventory management processes were developed. Vaccines from the federal Vaccines for Children program were used for eligible students. Third-party payers were billed for insured students; parents were not billed for services. RESULTS The proportion of enrolled students who received at least 1 dose of vaccine increased from year 1 to year 2 (elementary: 28% to 31%; middle: 12% to 19%). Issues identified and addressed included program planning with partners, development and implementation of billing processes, development of a solution to adhere to the Family Educational Rights and Privacy Act requirements, development and utilization of an easy-to-comprehend consent form, and implementation of standard work procedures. CONCLUSIONS This SLV program offered an alternative approach for providing vaccinations to students outside of the primary care setting. To be successful, ongoing partnerships are needed.
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Affiliation(s)
- Judith C Shlay
- University of Colorado Denver, Anschutz Medical Campus, 12631 East 17th Avenue, Aurora, CO 80045.
- Denver Public Health Department, Denver Health Immunization and Travel Clinic, 605 Bannock Street, Denver, CO 80204.
| | - Sarah Rodgers
- Denver Public Health Department, Denver Public Health Immunization and Travel Clinic, 605 Bannock Street, Denver, CO 80204.
| | - Jean Lyons
- Division of Student Services, Department of Nursing and Student Health Services, Denver Public Schools, 780 Grant Street, Denver, CO 80203.
| | - Scott Romero
- Division of Student Services, Denver Public Schools, 780 Grant Street, Denver, CO 80203.
| | - Tara M Vogt
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE., Atlanta, GA 30333.
| | - Emily V McCormick
- Denver Public Health Department, 605 Bannock Street, Denver, CO 80204.
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Kempe A, Daley MF, Pyrzanowski J, Vogt T, Fang H, Rinehart DJ, Morgan N, Riis M, Rodgers S, McCormick E, Hammer A, Campagna EJ, Kile D, Dickinson M, Hambidge SJ, Shlay JC. School-located influenza vaccination with third-party billing: outcomes, cost, and reimbursement. Acad Pediatr 2014; 14:234-40. [PMID: 24767776 DOI: 10.1016/j.acap.2014.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 01/10/2014] [Accepted: 01/21/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess rates of immunization; costs of conducting clinics; and reimbursements for a school-located influenza vaccination (SLIV) program that billed third-party payers. METHODS SLIV clinics were conducted in 19 elementary schools in the Denver Public School district (September 2010 to February 2011). School personnel obtained parental consent, and a community vaccinator conducted clinics and performed billing. Vaccines For Children vaccine was available for eligible students. Parents were not billed for any fees. Data were collected regarding implementation costs and vaccine cost was calculated using published private sector prices. Reimbursement amounts were compared to costs. RESULTS Overall, 30% of students (2784 of 9295) received ≥1 influenza vaccine; 39% (1079 of 2784) needed 2 doses and 80% received both. Excluding vaccine costs, implementation costs were $24.69 per vaccination. The percentage of vaccine costs reimbursed was 62% overall (82% from State Child Health Insurance Program (SCHIP), 50% from private insurance). The percentage of implementation costs reimbursed was 19% overall (23% from private, 27% from Medicaid, 29% from SCHIP and 0% among uninsured). Overall, 25% of total costs (implementation plus vaccine) were reimbursed. CONCLUSIONS A SLIV program resulted in vaccination of nearly one third of elementary students. Reimbursement rates were limited by 1) school restrictions on charging parents fees, 2) low payments for vaccine administration from public payers and 3) high rates of denials from private insurers. Some of these problems might be reduced by provisions in the Affordable Care Act.
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Affiliation(s)
- Allison Kempe
- Children's Outcomes Research Program, The Children's Hospital, Aurora, Colo; Department of Pediatrics, University of Colorado, Aurora, Colo; Colorado Health Outcomes Program, University of Colorado, Aurora, Colo.
| | - Matthew F Daley
- Children's Outcomes Research Program, The Children's Hospital, Aurora, Colo; Department of Pediatrics, University of Colorado, Aurora, Colo; Institute for Health Research, Kaiser Permanente, Denver, Colo
| | | | - Tara Vogt
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Hai Fang
- Department of Health System, Management and Policy, University of Colorado, Aurora, Colo
| | | | | | - Mette Riis
- Denver Public Health, Denver Health, Denver, Colo
| | | | - Emily McCormick
- Institute for Health Research, Kaiser Permanente, Denver, Colo; Public Health Prevention Services, Centers for Disease Control and Prevention, Atlanta, Ga; Denver Public Health, Denver Health, Denver, Colo
| | - Anne Hammer
- Community Health Services, Denver Health, Denver, Colo
| | | | - Deidre Kile
- Colorado Health Outcomes Program, University of Colorado, Aurora, Colo
| | - Miriam Dickinson
- Children's Outcomes Research Program, The Children's Hospital, Aurora, Colo; Department of Family Medicine, University of Colorado, Aurora, Colo
| | - Simon J Hambidge
- Department of Pediatrics, University of Colorado, Aurora, Colo; Denver Public Health, Denver Health, Denver, Colo; Community Health Services, Denver Health, Denver, Colo
| | - Judith C Shlay
- Department of Family Medicine, University of Colorado, Aurora, Colo; Denver Public Health, Denver Health, Denver, Colo
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Humiston SG, Poehling KA, Szilagyi PG. School-located influenza vaccination: can collaborative efforts go the distance? Acad Pediatr 2014; 14:219-20. [PMID: 24767773 DOI: 10.1016/j.acap.2014.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 03/10/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Sharon G Humiston
- Department of Pediatrics, Children's Mercy Hospital and Clinics, Kansas City, MO.
| | | | - Peter G Szilagyi
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
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