Department of Medicine, University of Pittsburgh School of Medicine, 200 Meyran Ave., Suite 200, Pittsburgh, PA, 15213, USA.
Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
BMC Infect Dis. 2018 Jan 25;18(1):52. doi: 10.1186/s12879-018-2967-2.
Adults aged 18-64 years with comorbid conditions are at high risk for complications of certain vaccine-preventable diseases, including influenza and pneumococcal disease. The 4 Pillars™ Practice Transformation Program (4 Pillars Program) increases uptake of pneumococcal polysaccharide vaccine, influenza vaccine and tetanus-diphtheria-acellular pertussis vaccine by 5-10% among adults with high-risk medical conditions, but its cost-effectiveness is unknown.
A decision tree model estimated the cost-effectiveness of implementing the 4 Pillars Program in primary care practices compared to no program for a population of adults 18-64 years of age at high risk of illness complications over a 10 year time horizon. Vaccination rates and intervention costs were derived from a randomized controlled cluster trial in diverse practices in 2 U.S. cities. One-way and probabilistic sensitivity analyses were conducted.
From a third-party payer perspective, which considers direct medical costs, the 4 Pillars Program cost $28,301 per quality-adjusted life year gained; from a societal perspective, which adds direct nonmedical and indirect costs, the program was cost saving and more effective than no intervention. Cost effectiveness results favoring the program were robust in sensitivity analyses. From a public health standpoint, the model predicted that the intervention reduced influenza cases by 1.4%, with smaller decreases in pertussis and pneumococcal disease cases.
The 4 Pillars Practice Transformation Program is an economically reasonable, and perhaps cost saving, strategy for protecting the health of adults aged < 65 years with high-risk medical conditions.
18-64 岁患有合并症的成年人患某些可通过疫苗预防的疾病（包括流感和肺炎球菌病）并发症的风险较高。四支柱实践转型计划（4 Pillars Program）可将患有高危医疗条件的成年人对肺炎球菌多糖疫苗、流感疫苗和破伤风、白喉、无细胞百日咳疫苗的接种率提高 5-10%，但其成本效益尚不清楚。
决策树模型估计了在初级保健实践中实施 4 Pillars Program 与不实施该计划相比，在 10 年时间内对有患病并发症高风险的 18-64 岁成年人人群的成本效益。疫苗接种率和干预成本来自于在美国两个城市的多样化实践中的一项随机对照群集试验。进行了单因素和概率敏感性分析。
从第三方支付者的角度来看，考虑直接医疗成本，4 Pillars Program 每获得一个质量调整生命年的成本为 28,301 美元；从社会角度来看，加上直接非医疗和间接成本，该计划具有成本效益，并且比不干预更有效。在敏感性分析中，有利于该计划的成本效益结果是稳健的。从公共卫生的角度来看，该模型预测该干预措施将使流感病例减少 1.4%，而百日咳和肺炎球菌病病例的减少幅度较小。
四支柱实践转型计划是一种经济合理且可能具有成本效益的策略，可以保护 18-64 岁有高危医疗条件的成年人的健康。
