• Nianli Xing, Wing-Yin Cheung, Minghuan Jiang, and YouJoyce H SJHSSchool of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China. Electronic address: joyceyou@cuhk.edu.hk..
• Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China.
• Am J Infect Control. 2019 Nov 1; 47 (11): 1302-1308.

BackgroundClinical studies support a standing orders program (SOP) to improve vaccine uptake. We aimed to examine the potential cost-effectiveness of a pneumococcal vaccination SOP for Hong Kong elderly in a hospital setting.MethodsA decision-analytic model was designed to compare the outcomes of inpatients 65 years of age or older who were eligible for pneumococcal vaccination. Two vaccination approaches were evaluated: (1) vaccination SOP, and (2) no program (control group). Outcome measures included direct medical costs, invasive pneumococcal disease-associated mortality rates, quality-adjusted life year (QALY) losses, and incremental cost per QALY saved (ICER).ResultsIn the base-case analysis, mortality and QALY losses were lower and costs were higher in the SOP group when compared to the control group. The base-case ICER of the SOP group was $59,762 (all dollar amounts are in US$) per QALY saved. One-way sensitivity analyses found ICER to be sensitive to the probability of invasive pneumococcal disease among the unvaccinated elderly. Using 1× the gross domestic product per capita of Hong Kong ($43,497) and the United States ($150,000) as willingness-to-pay thresholds, SOPs were the preferred option in 37.2% and 97.5% of 10,000 Monte Carlo simulations, respectively.ConclusionsThe pneumococcal vaccination SOP for hospitalized elderly patients appeared to reduce QALY losses at a higher cost. The cost-effective acceptance of SOPs is highly dependent on the willingness-to-pay threshold.Copyright © 2019 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

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