KEYWORDS:
practice assessment, cost-effectiveness, missed opportunity

BACKGROUND:
A number of interventions have been suggested to improve immunization rates but there have been few analyses of their cost-effectiveness or the conditions required to establish cost-effectiveness. The Partnership of Immunization Providers (PIP) is a demonstration project pairing UCSD and community health networks to evaluate multiple interventions to improve immunization delivery.

OBJECTIVE(S):
To calculate the cost-effectiveness, expressed in dollars saved per immunized child, of PIP's intervention. To analyze differences between Phases I and II of the study.

METHOD(S):
PIP evaluated multiple interventions and measures of both outcome and process in fourteen public and private practices that serve a low-income urban population in San Diego. Interventions included CASA with feedback (AFIX), missed opportunity chart analysis, workflow analysis and quality improvement strategies, education and training. Multiple assessment/feedback cycles were completed in two phases.
The specific interventions in Phase I differed from Phase II. A cost-effectiveness ratio was calculated using 1) the differential cost of the immunization improvement activities between Phase I and Phase II and 2) the effectiveness, in terms of expected savings to society. Both direct and indirect costs were included in this analysis and were conducted from the societal perspective. Costs are in 2001 dollars based upon the Bureau of Labor Statistics consumer price index.

RESULT(S):
In Phase I, real immunization rates rose 11.8% in the study population, whereas in Phase II there was no sustained rate increase. The more intense and expensive Phase I interventions had a more favorable cost-benefit ratio.

CONCLUSIONS(S):
Improving and maintaining immunization rates may require significant resources. The minimum expenditures required to sustain improved immunization delivery are yet to be determined but some minimum threshold is required.

LEARNING OBJECTIVES:
Participants will be able to describe a method for evaluating cost-effectiveness of immunization delivery and will understand the need to map interventions to circumstances.