Vaccine 29 (2011) 3525–3530 Contents lists available at ScienceDirect Vaccine journal homepage: www.elsevier.com/locate/vaccine Estimating the cost-effectiveness of a national program to eliminate disparities in influenza vaccination rates among elderly minority groups Constantinos I. Michaelidis a,* , Richard K. Zimmerman a,b , Mary Patricia Nowalk a,b , Kenneth J. Smith c a University of Pittsburgh School of Medicine, Pittsburgh, PA, United States b Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States c Section of Decision Sciences and Clinical Systems Modeling, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States article info Article history: Received 14 September 2010 Received in revised form 19 February 2011 Accepted 28 February 2011 Available online 12 March 2011 Keywords: Influenza Vaccination Disparities Cost-effectiveness abstract Influenza is a major cause of preventable morbidity and mortality in the United States, particularly among the elderly. Yet, there remain large disparities in influenza vaccination rates across elderly Caucasian (70%), African-American (50%) and Hispanic (55%) populations, with substantial mortality consequences. In this study, we built a decision-analysis model to estimate the cost-effectiveness of a hypothetical national vaccination program designed to eliminate these disparities in influenza vaccination rates. Tak- ing a societal perspective, we developed a Markov model with a one-year cycle length and lifetime time horizon. In the base case, we conservatively assumed that the cost of promoting the vaccination program was $10 per targeted elder per year and that by year 10, the vaccination rate of the elderly African-American and Hispanic populations would equal the vaccination rate of the elderly Caucasian population (70%). The cost-effectiveness of the vaccination program compared to no vaccination pro- gram was $48,617 per QALY saved. Probabilistic sensitivity analyses suggested that at willingness-to-pay thresholds of $50,000 and $100,000 per QALY saved, the likelihood of the vaccination program being cost- effective was 38% and 92%, respectively. In an analysis using conservative assumptions, we found that a hypothetical program to ameliorate disparities in influenza vaccination rates has a moderate to high likelihood of being cost-effective. © 2011 Elsevier Ltd. All rights reserved. 1. Introduction Accounting for more than 200,000 hospitalizations and 30,000 deaths annually, influenza is a major cause of preventable morbid- ity and mortality in the United States [1–3]. Elderly populations are particularly vulnerable, with estimates suggesting that 90% of influenza-attributable deaths occur among people older than age 65 [2]. The clinical benefits of seasonal influenza vaccination in elderly populations are well established [4,5]. Yet, influenza vaccination rates in the United States remain far below the 90% target set by the Healthy People 2010 objective and there are large disparities in vac- cination rates across minority groups. In those older than 65, only 70% of Caucasians, 50% of African-Americans and 55% of Hispan- ics reported receiving influenza vaccination in 2008 [6]. Due to the particular vulnerability of elderly populations, these disparities in influenza vaccination have real mortality consequences. Estimates * Corresponding author at: University of Pittsburgh School of Medicine, M240 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, 15261, United States. E-mail address: michaelidis.constant@medstudent.pitt.edu (C.I. Michaelidis). suggest that more than 1800 deaths per year could be prevented by eliminating disparities in influenza vaccination rates across racial groups [7]. Although there is an extensive body of literature regarding the cost-effectiveness of influenza vaccination in a variety of populations, to our knowledge, no studies have examined the cost- effectiveness of interventions aimed specifically at eliminating disparities in influenza vaccination among minority populations. To this end, we developed a Markov decision analysis model to estimate the cost-effectiveness of a hypothetical national influenza vaccination program designed to eliminate known disparities in influenza vaccination in elderly African-American and Hispanic populations. 2. Methods 2.1. Perspective and target population In the base case analysis, we assumed a societal perspective and included both direct medical and direct non-medical costs according to the guidelines of Gold et al. [8]. In a secondary anal- ysis, we assumed a third party payer perspective and included only direct medical costs. Our hypothetical cohort was the African- 0264-410X/$ – see front matter © 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.vaccine.2011.02.098