Cost effectiveness analysis of Year 2 of an elementary school-located XXXX vaccination program-Results from a randomized controlled trial.

@entity1 @entity683
BACKGROUND: School-located vaccination against @entity683 (SLV-I) has the potential to improve current suboptimal @entity683 immunization coverage for U.S. school-aged @entity1 . However, little is known about SLV-I's cost-effectiveness. The objective of this study is to establish the cost-effectiveness of SLV-I based on a two-year community-based randomized controlled trial (Year 1: 2009-2010 vaccination season, an unusual H1N1 pandemic @entity683 season, and Year 2: 2010-2011, a more typical @entity683 season). METHODS: We performed a cost-effectiveness analysis on a two-year randomized controlled trial of a Western New York SLV-I program. SLV-I clinics were offered in 21 intervention elementary schools (Year 1 n   =   9,027; Year 2 n   =   9,145 @entity1 ) with standard-of-care (no SLV-I) in control schools (Year 1 n   =   4,534 (10 schools); Year 2 n   =   4,796 @entity1 (11 schools)). We estimated the cost-per-vaccinated @entity1 , by dividing the incremental cost of the intervention by the incremental effectiveness (i.e., the number of additionally vaccinated students in intervention schools compared to control schools). RESULTS: In Years 1 and 2, respectively, the effectiveness measure (proportion of @entity1 vaccinated) was 11.2 and 12.0 percentage points higher in intervention (40.7  % and 40.4  %) than control schools. In year 2, the cost-per-vaccinated @entity1 excluding vaccine purchase ( 59.88 in 2010 US  ) consisted of three component costs: (A) the school costs ( 8.25); (B) the project coordination costs ( 32.33); and (C) the vendor costs excluding vaccine purchase ( 16.68), summed through Monte Carlo simulation. Compared to Year 1, the two component costs (A) and (C) decreased, while the component cost (B) increased in Year 2. The cost-per-vaccinated @entity1 , excluding vaccine purchase, was  59.73 (Year 1) and  59.88 (Year 2, statistically indistinguishable from Year 1), higher than the published cost of providing @entity683 vaccination in medical practices ( 39.54). However, taking indirect costs (e.g., averted parental costs to visit medical practices) into account, vaccination was less costly in SLV-I ( 23.96 in Year 1,  24.07 in Year 2) than in medical practices. CONCLUSIONS: Our two-year trial's findings reinforced the evidence to support SLV-I as a potentially favorable system to increase childhood @entity683 vaccination rates in a cost-efficient way. Increased efficiencies in SLV-I are needed for a sustainable and scalable SLV-I program.
