Cost-effectiveness of pneumococcal and influenza vaccination standing order programs

Am J Manag Care. 2013 Jan 1;19(1):e30-7.


Objectives: Despite the benefits of vaccination and guidelines for their use, the rates for influenza and pneumococcal vaccination remain below the 90% goal set by Healthy People 2010 for persons 65 years and older. Standing order programs (SOPs) authorize vaccination administration without physician orders. Here we examine the cost-effectiveness of SOPs to improve both pneumococcal and influenza vaccination rates in outpatient settings for individuals 65 years and older.

Study design: Decision analysis-based cost-effectiveness analysis.

Methods: A Markov model was constructed to estimate the incremental cost-effectiveness of outpatient SOPs for pneumococcal polysaccharide vaccine (PPSV) and influenza vaccination in hypothetical US population cohorts 65 years and older. Vaccination rate improvement data were obtained from the medical literature. Centers for Disease Control and Prevention Active Bacterial Core surveillance data and US national databases were used to estimate costs and outcomes.

Results: SOPs cost $14,171 per quality-adjusted life-year (QALY) gained compared with no program from a third-party payer perspective. In 1-way sensitivity analyses, the SOP strategy cost less than $50,000/QALY if SOPs increased absolute vaccination rates by 4% or more (base case: 18%), annual SOP costs were less than $21 per person (base case: $4.60), or annual influenza incidence was 4% or more (base case: 10%). Model results were insensitive to other individual parameter variations, and were supported by a probabilistic sensitivity analysis.

Conclusions: SOPs used to improve PPSV and influenza vaccination rates in outpatient settings is a promising and economically favorable investment, with cost-effectiveness analysis results remaining robust to parameter variation over clinically plausible ranges.

MeSH terms

  • Aged
  • Cost-Benefit Analysis
  • Humans
  • Immunization Programs / economics*
  • Immunization Programs / organization & administration
  • Influenza Vaccines / economics*
  • Influenza Vaccines / therapeutic use
  • Influenza, Human / economics
  • Influenza, Human / prevention & control
  • Markov Chains
  • Pneumococcal Infections / economics
  • Pneumococcal Infections / prevention & control
  • Pneumococcal Vaccines / economics*
  • Pneumococcal Vaccines / therapeutic use
  • Quality-Adjusted Life Years
  • United States


  • Influenza Vaccines
  • Pneumococcal Vaccines