The effect of influenza and pneumococcal vaccination in the elderly on health service utilisation and costs: a claims data-based cohort study.
Claims data
Cost
Elderly
Health care utilisation
Influenza vaccination
Pneumococcal vaccination
Real-world data
Journal
The European journal of health economics : HEPAC : health economics in prevention and care
ISSN: 1618-7601
Titre abrégé: Eur J Health Econ
Pays: Germany
ID NLM: 101134867
Informations de publication
Date de publication:
Feb 2022
Feb 2022
Historique:
received:
14
07
2020
accepted:
01
07
2021
pubmed:
21
7
2021
medline:
3
3
2022
entrez:
20
7
2021
Statut:
ppublish
Résumé
To date, cost-effectiveness of influenza and pneumococcal vaccinations was assumed in several health economic modelling studies, but confirmation by real-world data is sparse. The aim of this study is to assess the effects on health care utilisation and costs in the elderly using real-world data on both, outpatient and inpatient care. Retrospective community-based cohort study with 138,877 individuals aged ≥ 60 years, insured in a large health insurance fund in Thuringia (Germany). We assessed health care utilisation and costs due to influenza- or pneumococcal-associated diseases, respiratory infections, and sepsis in 2015 and 2016. Individuals were classified into four groups according to their vaccination status from 2008 to 2016 (none, both, or either only influenza or pneumococcal vaccination). Inverse probability weighting based on 236 pre-treatment covariates was used to adjust for potential indication and healthy vaccinee bias. Influenza vaccination appeared as cost-saving in 2016, with lower disease-related health care costs of - €178.87 [95% CI - €240.03;- €117.17] per individual (2015: - €50.02 [95% CI - €115.48;€15.44]). Cost-savings mainly resulted from hospital inpatient care, whereas higher costs occurred for outpatient care. Overall cost savings of pneumococcal vaccination were not statistically significant in both years, but disease-related outpatient care costs were lower in pneumococci-vaccinated individuals in 2015 [- €9.43; 95% CI - €17.56;- €1.30] and 2016 [- €12.93; 95% CI - €25.37;- €0.48]. Although we used complex adjustment, residual bias cannot be completely ruled out. Influenza and pneumococcal vaccination in the elderly can be cost-saving in selective seasons and health care divisions. As cost effects vary, interpretation of findings is partly challenging.
Sections du résumé
BACKGROUND
BACKGROUND
To date, cost-effectiveness of influenza and pneumococcal vaccinations was assumed in several health economic modelling studies, but confirmation by real-world data is sparse. The aim of this study is to assess the effects on health care utilisation and costs in the elderly using real-world data on both, outpatient and inpatient care.
METHODS
METHODS
Retrospective community-based cohort study with 138,877 individuals aged ≥ 60 years, insured in a large health insurance fund in Thuringia (Germany). We assessed health care utilisation and costs due to influenza- or pneumococcal-associated diseases, respiratory infections, and sepsis in 2015 and 2016. Individuals were classified into four groups according to their vaccination status from 2008 to 2016 (none, both, or either only influenza or pneumococcal vaccination). Inverse probability weighting based on 236 pre-treatment covariates was used to adjust for potential indication and healthy vaccinee bias.
RESULTS
RESULTS
Influenza vaccination appeared as cost-saving in 2016, with lower disease-related health care costs of - €178.87 [95% CI - €240.03;- €117.17] per individual (2015: - €50.02 [95% CI - €115.48;€15.44]). Cost-savings mainly resulted from hospital inpatient care, whereas higher costs occurred for outpatient care. Overall cost savings of pneumococcal vaccination were not statistically significant in both years, but disease-related outpatient care costs were lower in pneumococci-vaccinated individuals in 2015 [- €9.43; 95% CI - €17.56;- €1.30] and 2016 [- €12.93; 95% CI - €25.37;- €0.48]. Although we used complex adjustment, residual bias cannot be completely ruled out.
CONCLUSION
CONCLUSIONS
Influenza and pneumococcal vaccination in the elderly can be cost-saving in selective seasons and health care divisions. As cost effects vary, interpretation of findings is partly challenging.
Identifiants
pubmed: 34283323
doi: 10.1007/s10198-021-01343-8
pii: 10.1007/s10198-021-01343-8
pmc: PMC8882088
doi:
Substances chimiques
Influenza Vaccines
0
Pneumococcal Vaccines
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
67-80Subventions
Organisme : Bundesministerium für Bildung und Forschung
ID : 03ZZ0819B
Informations de copyright
© 2021. The Author(s).
Références
Am J Prev Med. 2013 Apr;44(4):373-381
pubmed: 23498103
Vaccine. 2013 Jan 11;31(4):632-8
pubmed: 23212027
Clin Infect Dis. 2012 Jun;54(12):1778-83
pubmed: 22423139
Stat Med. 2013 Aug 30;32(19):3388-414
pubmed: 23508673
Clin Infect Dis. 2010 Nov 1;51(9):1007-16
pubmed: 20887208
Pharmacoeconomics. 1999;16 Suppl 1:63-71
pubmed: 10623378
Vaccine. 2010 Oct 8;28(43):7063-9
pubmed: 20723631
Psychol Methods. 2004 Dec;9(4):403-25
pubmed: 15598095
BMC Public Health. 2018 Jul 16;18(1):885
pubmed: 30012141
Expert Rev Vaccines. 2017 Feb;16(2):93-107
pubmed: 27680425
Hum Vaccin Immunother. 2015;11(4):818-25
pubmed: 25933180
BMC Infect Dis. 2015 Oct 17;15:429
pubmed: 26474974
J Infect Dis. 1998 Jul;178(1):53-60
pubmed: 9652423
Hum Vaccin Immunother. 2021 Jun 3;17(6):1844-1852
pubmed: 33412080
Eur Respir J. 2011 Jul;38(1):147-53
pubmed: 21148226
JAMA. 2012 Feb 22;307(8):804-12
pubmed: 22357831
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2016 Dec;59(12):1623-1657
pubmed: 27885449
Vaccine. 2013 Aug 20;31(37):3950-6
pubmed: 23806240
Eur J Health Econ. 2011 Jun;12(3):189-91
pubmed: 21267623
PLoS Med. 2015 Oct 06;12(10):e1001885
pubmed: 26440803
BMJ. 2012 Oct 26;345:e6879
pubmed: 23103369
Hum Vaccin Immunother. 2017 Mar 4;13(3):533-542
pubmed: 27780425
J Infect. 2012 Sep;65(3):231-8
pubmed: 22561486
Vaccine. 2002 Dec 20;20 Suppl 5:B50-4
pubmed: 12477420
JAMA. 2013 Oct 23;310(16):1711-20
pubmed: 24150467
Clin Infect Dis. 2018 Feb 1;66(4):541-547
pubmed: 29029063
Gesundheitswesen. 2016 Sep;78(S 01):e161
pubmed: 27428525
BMJ Open. 2017 Jun 10;7(6):e014847
pubmed: 28601824
Eur J Public Health. 2020 Apr 1;30(2):275-280
pubmed: 32060508
J Infect Dis. 2010 Jan 15;201(2):186-9
pubmed: 19995265
Int J Epidemiol. 2006 Apr;35(2):337-44
pubmed: 16368725
Eur Respir J. 2004 Mar;23(3):363-8
pubmed: 15065822
Int J Epidemiol. 2006 Apr;35(2):345-52
pubmed: 16368724