KEYWORDS:
Adult Immunization
Influenza Vaccine
Pnuemococcal Vaccine
Standing Orders Programs
Long-Term Care
Cost
Cost-Effectiveness

BACKGROUND:
Standing orders programs (SOPs) are policies that authorize non-physician staff to vaccinate without direct physician involvement at the time of the vaccination. Although the ACIP recommends SOPs to improve influenza and pneumococcal vaccine coverage in nursing home (NH) residents, no systematic studies of program costs or the cost-effectiveness of SOPs have been published.

OBJECTIVE(S):
Objectives of this study are to estimate the NH and societal costs of implementing SOPs for influenza immunizations and to assess the cost-effectiveness of SOPs, where the measure of program effectiveness is coverage rate for each vaccine.

METHOD(S):
Data on the value of resources used to develop and implement influenza immunization programs were collected from approximately 20 NHs (in 9 states) using mailed self-administered questionnaires (SAQs). Information about the type of immunization program in place was also collected using a separate SAQ. Program types included SOPs, pre-printed admission orders (PPAOs) placed in residents’ charts, reminder/education programs (REs) involving phone calls or post cards to physicians, and advance physician orders (APOs)—signed orders that cover all of a physician’s patients admitted. Mean per-resident costs were calculated for each immunization program type. Chart abstractions were used to estimate immunization coverage rates.

RESULT(S):
The per-resident societal cost estimate for SOPs was approximately $5.50. Cost estimates for PPOs, RRs, and APOs were $12.60 to $14 per person—significantly higher than SOP costs. Preliminary findings also suggest that influenza vaccination coverage rates are higher in NHs with SOPs (78%) than in those with other immunization programs (53%-72%). Incremental costs of adding pneumococcal vaccination to an existing influenza SOP will also be estimated.

CONCLUSIONS(S):
Findings suggest that many NHs could achieve higher immunization coverage rates at a lower per-resident cost by adopting SOPs.

LEARNING OBJECTIVES:
To understand how cost and cost-effectiveness analyses can be used in the evaluation of preventive interventions.