Does Influenza Vaccination of Older Adult Medicare Beneficiaries Lower Treatment Costs for Acute and Chronic Respiratory Disease?
Does Influenza Vaccination of Older Adult Medicare Beneficiaries Lower Treatment Costs for Acute and Chronic Respiratory Disease?
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DOI：
10.1016/j.amjopharm.2010.05.003
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发表时间：
2010-06-01
期刊：
影响因子：
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通讯作者：
Kemner, Jason
中科院分区：
文献类型：
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作者：
Stuart, Bruce;Davidoff, Amy;Kemner, Jason
背景资料：流感占老年人住院和死亡的很大比例，导致大量的医疗保健费用。流感疫苗接种在减少年轻人群呼吸道感染方面是有效的，但不太确定它们是否能减少老年人呼吸道感染的相关费用。目的：本研究的目的是确定老年人医疗保险受益人的流感疫苗接种是否能减少最近3个流感季节急性和慢性呼吸道疾病的相关费用。本研究分析了2002年至2005年流感季节（10月至5月）期间>= 55岁的医疗保险受益人中流感疫苗接种和呼吸系统疾病费用之间的关系，使用的数据来自医疗保险当前受益人调查。在控制流感风险因素和其他协变量的情况下，根据每个流感季节治疗呼吸系统疾病的概率和成本，对疫苗接种状态进行两部分多元回归估计。各种敏感性测试进行了服务类型，亚组分析特定人群的风险段，倾向评分匹配的比较，和difference equations.Results：研究样本包括13,402医疗保险受益人的3个流感季节检查。3个流感季节的疫苗接种率在67.3%和74.9%之间。在未经调整的比较中，2002/2003年接种疫苗和未接种疫苗的受益人之间治疗呼吸系统疾病的费用没有显著差异（-104美元），但在最近的流感季节，接种疫苗的受益人的平均费用差异显著更高（2003/2004年258美元，P = 0.012; 2004/2005年254美元，P = 0.003）。根据3个季节的疫苗状态的2部分多重回归分析，接种疫苗的受益人的呼吸系统疾病费用平均高出142美元（P = 0.014）。基础回归模型显示，任何一年的疫苗接种都没有显著的成本节约。进行的54次敏感性测试中有2次的结果表明，接种疫苗可节省大量费用（2002/2003年住院费用以及2002/2003年未接种疫苗但2003/2004年接种疫苗的人的总费用差异）。在这项针对老年人的研究中，在检查的3个流感季节中，没有发现流感疫苗的显著成本节约（2002-2005年），当时的结果是衡量急性和慢性呼吸系统疾病的不同支出。(Am老年药理学杂志。2010;8：201-214）（C）2010 Excerpta Medica Inc.
Background: Influenza accounts for a large proportion of hospitalizations and deaths among older adults, resulting in substantial health care expenses. Influenza vaccinations are effective in reducing respiratory infections in younger populations, but it is less certain whether they reduce costs associated with respiratory infections among older adults.Objective: The purpose of this study was to determine whether influenza vaccination of older adult Medicare beneficiaries reduced costs associated with acute and chronic respiratory conditions during 3 recent influenza seasons.Methods: This study analyzed the relationship between influenza vaccination and costs for respiratory conditions among Medicare beneficiaries >= 55 years of age in influenza seasons (October May) between 2002 and 2005 using data from the Medicare Current Beneficiary Survey. Two-part multiple regressions of vaccination status were estimated on the probability and cost of treating respiratory conditions in each influenza season controlling for influenza risk factors and other covariates. Various sensitivity tests were conducted by type of service, subgroup analysis for specific population risk segments, propensity score-matched comparisons, and difference equations.Results: The study sample included 13,402 Medicare beneficiaries for the 3 influenza seasons examined. Vaccination rates varied between 67.3% and 74.9% over the 3 influenza seasons. In unadjusted comparisons, no significant difference in the cost of treating respiratory conditions was found between vaccinated and unvaccinated beneficiaries in 2002/2003 (-$104), but vaccinated beneficiaries had significantly higher mean cost differentials in the more recent influenza seasons ($258 in 2003/2004, P = 0.012; $254 in 2004/2005, P = 0.003). Based on 2-part multiple regressions of vaccine status over the 3 seasons combined, costs of respiratory conditions were $142 dollars higher on average for vaccinated beneficiaries (P = 0.014). The base regression models showed no significant cost savings from vaccination in any year. Results of 2 of the 54 sensitivity tests that were conducted indicated significant savings from vaccination (inpatient costs for 2002/2003 and difference in total costs for persons unvaccinated in 2002/2003 but vaccinated in 2003/2004).Conclusion: In this study of older adults, no significant cost savings were found with influenza vaccines in the 3 influenza seasons examined (2002-2005) when the outcome was measured in terms of differential spending for acute and chronic respiratory conditions. (Am J Geriatr Pharmacother. 2010;8:201-214) (C) 2010 Excerpta Medica Inc.