Brown School of Public Health, Health Service Policy & Practice, Providence, RI; Center for Gerontology & Healthcare Research, Providence, RI.
Brown School of Public Health, Health Service Policy & Practice, Providence, RI; Center for Gerontology & Healthcare Research, Providence, RI.
J Am Med Dir Assoc. 2019 Jul;20(7):874-878. doi: 10.1016/j.jamda.2018.12.003. Epub 2019 Feb 15.
Influenza is a leading cause of avoidable admissions for nursing home (NH) residents. We previously evaluated the effectiveness of a high-dose trivalent influenza vaccine (HD) compared to a standard-dose influenza vaccine (SD) through a cluster-randomized trial of NH residents. Fewer residents from facilities randomized to HD were hospitalized. In this article, we extend our analyses to consider direct medical care costs relative to vaccine costs for HD ($31.82/dose) as compared to SD ($12.04/dose).
Post hoc, cost-benefit analysis.
From the participating NH facilities (n = 817), we identified Medicare fee-for-service enrollees who were long-stay residents (>100 days) at the start of the 2013-2014 influenza season (November 1-May 31). The intervention was residence in a facility randomized to HD or SD influenza vaccine.
We summed expenditures from long-stay NH residents' Medicare Part A, B, and D fee-for-service claims and compared person-level expenditures between residents of facilities offering HD vs SD. Expenditures were adjusted for clustering of residents within NHs, person-time, and prespecified covariates using 2-part, generalized linear models with bootstrapped standard errors. We examined the incremental cost-benefit of HD vs SD vaccines from a payer perspective.
There were 18,605 and 18,658 Medicare fee-for-service long-stay residents in facilities offering HD and SD, respectively. Person- and facility-adjusted total expenditures differed by $546 (P = .006). The $20 incremental cost of HD to SD offset adjusted expenditures for a net benefit of $526 per NH resident and a financial return on investment of 546/20 = 27:1.
CONCLUSIONS/IMPLICATIONS: The use of HD influenza vaccine in long-stay NH residents reduced total health care expenditures for a net benefit despite HD being more expensive per dose. These cost offsets applied to Medicare beneficiaries residing in NHs could result in important savings to the Medicare program.
流感是导致养老院（NH）居民可避免住院的主要原因。我们之前通过一项 NH 居民的整群随机试验评估了高剂量三价流感疫苗（HD）与标准剂量流感疫苗（SD）的有效性。接受 HD 疫苗接种的设施中的居民住院人数较少。在本文中，我们将分析范围扩展到考虑 HD（每剂 31.82 美元）与 SD（每剂 12.04 美元）相比的直接医疗保健成本相对于疫苗成本。
事后成本效益分析。
从参与的 NH 设施（n=817）中，我们确定了在 2013-2014 年流感季节（11 月 1 日至 5 月 31 日）开始时长期居住（>100 天）的 Medicare 按服务收费的参保人。干预措施是居住在接受 HD 或 SD 流感疫苗接种的设施中。
我们汇总了 Medicare 部分 A、B 和 D 按服务收费索赔中 NH 长期居民的支出，并比较了提供 HD 与 SD 的设施中居民的个人支出。使用具有自举标准误差的两部分广义线性模型，根据 NH 内居民的聚类、人员时间和预设协变量对支出进行了调整。我们从支付者的角度检查了 HD 与 SD 疫苗的增量成本效益。
提供 HD 和 SD 的设施中分别有 18605 名和 18658 名 Medicare 按服务收费的长期居民。个人和设施调整后的总支出差异为 546 美元（P=0.006）。HD 对 SD 的 20 美元增量成本抵消了调整后的支出，使 NH 每位居民的净收益为 526 美元，投资回报率为 546/20=27:1。
结论/意义：在长期 NH 居民中使用 HD 流感疫苗可降低总医疗保健支出，获得净收益，尽管每剂 HD 更昂贵。这些成本抵消适用于 Medicare 受益人居住在 NH 中，可能会为 Medicare 计划节省重要的资金。
