Abstract
BackgroundTo date, cost-effectiveness of influenza and pneumococcal vaccinations was assumed in several health economic modelling studies, but confirmation by real-world data is sparse. The aim of this study is to assess the effects on health care utilisation and costs in the elderly using real-world data on both, outpatient and inpatient care.MethodsRetrospective community-based cohort study with 138,877 individuals aged ≥ 60 years, insured in a large health insurance fund in Thuringia (Germany). We assessed health care utilisation and costs due to influenza- or pneumococcal-associated diseases, respiratory infections, and sepsis in 2015 and 2016. Individuals were classified into four groups according to their vaccination status from 2008 to 2016 (none, both, or either only influenza or pneumococcal vaccination). Inverse probability weighting based on 236 pre-treatment covariates was used to adjust for potential indication and healthy vaccinee bias.ResultsInfluenza vaccination appeared as cost-saving in 2016, with lower disease-related health care costs of − €178.87 [95% CI − €240.03;− €117.17] per individual (2015: − €50.02 [95% CI − €115.48;€15.44]). Cost-savings mainly resulted from hospital inpatient care, whereas higher costs occurred for outpatient care. Overall cost savings of pneumococcal vaccination were not statistically significant in both years, but disease-related outpatient care costs were lower in pneumococci-vaccinated individuals in 2015 [− €9.43; 95% CI − €17.56;− €1.30] and 2016 [− €12.93; 95% CI − €25.37;− €0.48]. Although we used complex adjustment, residual bias cannot be completely ruled out.ConclusionInfluenza and pneumococcal vaccination in the elderly can be cost-saving in selective seasons and health care divisions. As cost effects vary, interpretation of findings is partly challenging.
Highlights
Influenza and pneumococcal disease are important causes of death, morbidity, and money spent on related medical care worldwide [1]
138,877 individuals were included as study population (Fig. 2). 61,541 individuals were only vaccinated against influenza (IV), 1136 only against pneumococci (PV), 3333 had received vaccines against both diseases (BOTH) and 72,867 individuals were unvaccinated (NONE)
Parallel to the decrease of health care utilisation, costs in hospital inpatient care, and costs in emergency care, we found an increase in outpatient care after influenza vaccination
Summary
Influenza and pneumococcal disease are important causes of death, morbidity, and money spent on related medical care worldwide [1]. For individuals with underlying chronic conditions associated with high risk for pneumococcal infection (e.g., immunosuppression, chronic liver disease, or renal failure), vaccination against pneumococci is recommended as a sequential immunization using a 13-valent pneumococcal conjugate vaccine (PCV) followed by PPV, and a booster vaccination every 6 years [4]. The aim of this study is to assess the effects on health care utilisation and costs in the elderly using real-world data on both, outpatient and inpatient care. Overall cost savings of pneumococcal vaccination were not statistically significant in both years, but disease-related outpatient care costs were lower in pneumococci-vaccinated individuals in 2015 [− €9.43; 95% CI − €17.56;− €1.30] and 2016 [− €12.93; 95% CI − €25.37;− €0.48].
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