Middleton Donald B, Lin Chyongchiou J, Smith Kenneth J, Zimmerman Richard K, Nowalk Mary Patricia, Roberts Mark S, Fox Dwight E
Department of Family Medicine, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15232, USA.
Infect Control Hosp Epidemiol. 2008 May;29(5):385-94. doi: 10.1086/587155.
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.
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.
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%.
SOPs do increase PPV vaccination rates in hospitalized elderly patients and are economically favorable, compared with PPV vaccination rates without SOPs.
无需医生单独开具医嘱即可进行疫苗接种的常备医嘱项目（SOPs）是实现高疫苗接种率的最有效机制。医院住院科室是建议采用常备医嘱项目的场所之一，因为它们为最有可能从疫苗接种中获益的人群提供护理。这种方法对于老年住院患者的成本效益尚不清楚。本研究的目的是评估常备医嘱项目对65岁及以上患者在两种类型医院中接种肺炎球菌多糖疫苗（PPV）的成本效益。
2004年，一家拥有1094张床位的三级护理医院实施了基于药房的PPV常备医嘱项目，一家拥有225张床位的社区医院实施了基于护理的PPV常备医嘱项目。对新入院的65岁及以上患者进行PPV接种资格筛查，然后为其提供PPV疫苗。美国常备医嘱项目启动前后的疫苗接种率、美国侵袭性肺炎球菌疾病的发病率以及美国经济数据是成本效益分析的基础。进行了单因素和多因素敏感性分析。
三级护理医院的PPV疫苗接种率提高了30.5%，社区医院提高了15.3%。在基于社会视角的基础成本效益分析中，我们发现基于药房和基于护理的常备医嘱项目每获得一个质量调整生命年的成本均低于10,000美元，项目成本（基于药房的常备医嘱项目每位筛查患者成本为4.16美元，基于护理的常备医嘱项目每位筛查患者成本为4.60美元）和疫苗成本（每剂18.33美元）被避免的侵袭性肺炎球菌疾病病例的潜在节省部分抵消（每例12,436美元）。敏感性分析表明，与无常备医嘱项目的PPV疫苗接种相比，PPV疫苗接种的常备医嘱项目具有成本效益，除非疫苗接种率的提高低于8%。
与无常备医嘱项目的PPV疫苗接种率相比，常备医嘱项目确实提高了住院老年患者的PPV疫苗接种率，且在经济上更具优势。
