. 2019 Jul 12;10(3):10.24926/iip.v10i3.940. doi: 10.24926/iip.v10i3.940

Table 2. Economics.

Name of study and description	Type of study / objectives	Methods	Results	Implications
Cost of Adult vaccination in Medical Settings and Pharmacies: An observational study¹⁷ Singhal PK et al. J Manag Care Spec Pharm. 2014;20(9):930-6.	Observational retrospective study. Objective: To examine whether the direct medical costs paid for adult vaccination differ by vaccination setting.	This was an observational retrospective study using 2010 MarketScan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits databases. Adults receiving herpes zoster or shingles vaccine, pneumococcal vaccine 23-valent, or influenza vaccines were identified using Current Procedural Terminology codes and National Drug Code numbers from medical and pharmacy claims files, respectively, between January 1 and December 31, 2010, in 1 of the following 3 settings: physician offices; other medical settings (e.g., inpatient/outpatient hospitals, emergency rooms); and pharmacies. Patients were adults aged 60 years on the date of zoster vaccination and aged 19 years on the date of pneumococcal or influenza vaccinations. The final study samples meeting inclusion/exclusion criteria were 54,042 for zoster vaccine, 154,994 for pneumococcal vaccine, and 1,657,264 for influenza vaccine. The vaccination costs included the health plan and enrollee paid amounts for the product; vaccine administration; dispensing fee; and, where applicable, the visit. The mean (SD) vaccination costs paid per vaccine administrations were estimated by vaccine and type of setting, overall, and by geographic region and type of health plan. The costs paid for the same vaccine across vaccination settings were compared using analysis of variance with post hoc tests (Tukey).	Of those receiving zoster, pneumococcal, and influenza vaccines, 25%, 1%, and 7%, respectively, received the vaccines at a pharmacy. Compared with other U.S. regions, pharmacy-based vaccination for these 3 vaccines was generally more frequent in the West and the South. Mean (SD) costs paid per enrollee per vaccine administration at physician offices, other medical settings, and pharmacies were as follows: for zoster vaccine, $208.72 (42.10), $209.51 (50.83), and $168.50 (15.66), respectively (P<0.05); for pneumococcal vaccine, $65.69 (27.54), $72.11 (49.95), and $54.98 (9.72), respectively (P<0.05); and for influenza vaccine, $29.29 (15.29), $24.20 (13.12), and $21.57 (6.63), respectively (P<0.05). For all 3 vaccines, the costs paid were significantly lower in pharmacies than in either physician offices or other medical settings (P < 0.05). The mean amounts paid also differed by geographic region and type of health plan, with costs usually lower for the vaccinations given at pharmacies.	The average direct costs paid per adult vaccination were lower in pharmacies compared with physician offices and other medical settings by 16%-26% and 11%-20%, respectively. These results were mostly consistent across geographic regions and types of health plans. These data may help payers and policymakers understand the economic value of adult vaccination in different settings, especially in pharmacies. The data may also help medical or pharmacy insurance providers understand the economic value of expanding the vaccination schedule coverage to the pharmacy setting.
Non Traditional settings for influenza of Adults Costs and Cost Effectiveness¹⁸ Prosser LA et al. Pharmacoeconomics. 2008;26(2):163-78	To describe the cost of vaccination in non-traditional settings such as pharmacies and mass vaccinations clinics Evaluate the projected health benefits, cost and cost effectiveness of delivering influenza vaccinations to adults of varying ages and risk groups in non-traditional settings compared with schedule doctor’s office visits in the United States.	Evaluated cost of influenza vaccinations in non-traditional setting via detailed telephone interviews with vaccination clinics and pharmacists who administer vaccines Decision tree used to compare projected cost and health benefits of receiving an influenza vaccination from non-traditional setting or during schedule doctor office visit with no vaccination. Probabilities and cost (direct and opportunity) for uncomplicated influenza illness, outpatient visits, hospitalizations, deaths, vaccination and vaccine adverse events were derived from primary data and published and unpublished articles.	The mean cost (2004 values) was lower in mass vaccination ($17.04) and pharmacy ($11.57) setting than in scheduled office visits. In non-traditional settings, cost savings was projected for healthy adults aged ≥ 50 years and for high-risk adults of all ages. For health adults 18-49 years was cost effective, prevention ($US90) if vaccines delivered in pharmacy setting, $US210 by mass vaccination, and $US870 by scheduled doctor’s office visit.	Vaccinations given in the pharmacy setting is the most cost effective way to administer vaccines. Vaccines given in pharmacy can lower the cost to patients and to health providers.

Name of study and description

Type of study / objectives

Methods

Results

Implications

Cost of Adult vaccination in Medical Settings and Pharmacies: An observational study¹⁷

Singhal PK et al. J Manag Care Spec Pharm. 2014;20(9):930-6.

Observational retrospective study.

Objective: To examine whether the direct medical costs paid for adult vaccination differ by vaccination setting.

This was an observational retrospective study using 2010 MarketScan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits databases. Adults receiving herpes zoster or shingles vaccine, pneumococcal vaccine 23-valent, or influenza vaccines were identified using Current Procedural Terminology codes and National Drug Code numbers from medical and pharmacy claims files, respectively, between January 1 and December 31, 2010, in 1 of the following 3 settings: physician offices; other medical settings (e.g., inpatient/outpatient hospitals, emergency rooms); and pharmacies. Patients were adults aged 60 years on the date of zoster vaccination and aged 19 years on the date of pneumococcal or influenza vaccinations. The final study samples meeting inclusion/exclusion criteria were 54,042 for zoster vaccine, 154,994 for pneumococcal vaccine, and 1,657,264 for influenza vaccine. The vaccination costs included the health plan and enrollee paid amounts for the product; vaccine administration; dispensing fee; and, where applicable, the visit. The mean (SD) vaccination costs paid per vaccine administrations were estimated by vaccine and type of setting, overall, and by geographic region and type of health plan. The costs paid for the same vaccine across vaccination settings were compared using analysis of variance with post hoc tests (Tukey).

Of those receiving zoster, pneumococcal, and influenza vaccines, 25%, 1%, and 7%, respectively, received the vaccines at a pharmacy. Compared with other U.S. regions, pharmacy-based vaccination for these 3 vaccines was generally more frequent in the West and the South.

Mean (SD) costs paid per enrollee per vaccine administration at physician offices, other medical settings, and pharmacies were as follows: for zoster vaccine, $208.72 (42.10), $209.51 (50.83), and $168.50 (15.66), respectively (P<0.05); for pneumococcal vaccine, $65.69 (27.54), $72.11 (49.95), and $54.98 (9.72), respectively (P<0.05); and for influenza vaccine, $29.29 (15.29), $24.20 (13.12), and $21.57 (6.63), respectively (P<0.05).

For all 3 vaccines, the costs paid were significantly lower in pharmacies than in either physician offices or other medical settings (P < 0.05).

The mean amounts paid also differed by geographic region and type of health plan, with costs usually lower for the vaccinations given at pharmacies.

The average direct costs paid per adult vaccination were lower in pharmacies compared with physician offices and other medical settings by 16%-26% and 11%-20%, respectively.

These results were mostly consistent across geographic regions and types of health plans.

These data may help payers and policymakers understand the economic value of adult vaccination in different settings, especially in pharmacies.

The data may also help medical or pharmacy insurance providers understand the economic value of expanding the vaccination schedule coverage to the pharmacy setting.

Non Traditional settings for influenza of Adults

Costs and Cost Effectiveness¹⁸

Prosser LA et al. Pharmacoeconomics. 2008;26(2):163-78

To describe the cost of vaccination in non-traditional settings such as pharmacies and mass vaccinations clinics

Evaluate the projected health benefits, cost and cost effectiveness of delivering influenza vaccinations to adults of varying ages and risk groups in non-traditional settings compared with schedule doctor’s office visits in the United States.

Evaluated cost of influenza vaccinations in non-traditional setting via detailed telephone interviews with vaccination clinics and pharmacists who administer vaccines

Decision tree used to compare projected cost and health benefits of receiving an influenza vaccination from non-traditional setting or during schedule doctor office visit with no vaccination.

Probabilities and cost (direct and opportunity) for uncomplicated influenza illness, outpatient visits, hospitalizations, deaths, vaccination and vaccine adverse events were derived from primary data and published and unpublished articles.

The mean cost (2004 values) was lower in mass vaccination ($17.04) and pharmacy ($11.57) setting than in scheduled office visits.

In non-traditional settings, cost savings was projected for healthy adults aged ≥ 50 years and for high-risk adults of all ages.

For health adults 18-49 years was cost effective, prevention ($US90) if vaccines delivered in pharmacy setting, $US210 by mass vaccination, and $US870 by scheduled doctor’s office visit.

Vaccinations given in the pharmacy setting is the most cost effective way to administer vaccines.

Vaccines given in pharmacy can lower the cost to patients and to health providers.