BACKGROUND:
Several studies have shown that standing orders (SOs) are an effective strategy for increasing influenza and pneumococcal vaccination coverage rates in inpatient settings. SOs for adult immunization have been recommended by the Advisory Committee on Immunization Practices.

OBJECTIVE:
To assess the cost-effectiveness of SOs in the hospital setting.

METHOD:
Data on the costs and effectiveness of hospital-based SOs, physician reminders (PRs), and pre-printed orders (PPOs) programs for influenza and pneumococcal immunization were collected from 13 North Carolina hospitals. These data were used to estimate vaccination coverage rates for each program type (SO, PPO, PR, and controls) as the ratio of the number of vaccine orders to the number of patients eligible for a vaccine. Costs were estimated per person screened. The incremental cost-effectiveness of SOs was considered as compared to non-SO programs and as compared to “control” hospitals with no organized immunization program.

RESULT:
Findings indicated that SOs cost approximately $9 per additional vaccine ordered as compared to control sites. When compared to PPOs and PRs, SOs were found to be cost saving (i.e., had higher coverage rates and lower costs).

CONCLUSION:
In our sample of NC hospitals, SOs for adult immunization were found to have acceptable cost-effectiveness ratios. Further, SOs were cost saving as compared to PPOs and PRs. SOs may be a cost-effective strategy for increasing adult vaccination rates among high-risk and elderly hospital patients.

LEARNING OBJECTIVES:
1. To understand the definition of standing orders in the hospital setting used in this study.
2. To understand the approach applied to assess cost-effectiveness and be able to interpret the results.