Abstract
Context: In 1994, immunization against hepatitis B was implemented in schools in Quebec, targeting grade 4 students. In 1996–1997 and 1997–1998, one Local Community Service Centre (CLSC) replaced the school-based program in its district with vaccination offered in community clinics after school hours. The aim of the current study was to compare the effectiveness and costs of school-based and clinic-based programs.
Methods: Vaccination coverage data were collected in the CLSC with the clinic-based program (CBP), and in three matched CLSCs with a school-based program (SBP), from 1994 to 2000. Surveys were conducted to estimate costs to parents, to schools and to CLSCs in 1997–1998.
Results: With the implementation of the CBP, the vaccination coverage fell to 73%, compared with over 90% in the SBPs. Coverage increased to 90% when the CBP was abandoned. Costs to the CLSC were not much lower in the CBP. Societal costs were $63 per student vaccinated in the CBP, and ≤40 in the SBPs.
Conclusion: Results demonstrate the advantage of a SBP over a CBP for the immunization of schoolchildren.
Résumé
Contexte: Un programme de vaccination contre l’hépatite B existe au Québec depuis 1994 où les élèves de 4e année sont vaccinés à l’école. En 1996–1997 et 1997–1998, un Centre local des services communautaires (CLSC) a remplacé le programme scolaire dans son territoire par la vaccination offerte lors de cliniques communautaires spéciales, après les heures de classe. Le but de cette étude était de comparer l’efficacité et les coûts sociétaux du programme de vaccination offert à l’école et celui lors de cliniques communautaires.
Méthode: L’étude fut réalisée dans le CLSC offrant la vaccination en clinique (VC) et dans trois CLSC appariés offrant la vaccination en milieu scolaire (VS). Les couvertures vaccinales furent comparées de 1994 à 2000. Des enquêtes furent menées pour décrire les coûts assumés par les parents, les écoles et les CLSC pour l’année 1997–1998.
Résultats: La couverture vaccinale obtenue par la VC en 1997–1998 a chuté à 73 % alors qu’elle était supérieure à 90 % dans le groupe contrôle. Le taux de vaccination a augmenté à plus de 90 % lorsque la VC a été abandonnée. La VC n’a pas entraîné de réduction importante des coûts pour le CLSC. Le coût sociétal par élève vacciné par la VC a été de 63 $, mais ≤40 $ avec la VS.
Conclusion: Ces résultats démontrent les nets avantages d’offrir la vaccination en milieu scolaire.
Footnotes
Acknowledgement: This study was funded by the “Programme conjoint MSSS-RRSSS de subvention en santé publique”.
References
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