The effect of influenza and pneumococcal vaccination in the elderly on health service utilisation and costs: a claims data-based cohort study

Abstract

Background To date, cost-effectiveness of influenza and pneumococcal vaccinations was assumed in several health economic modelling studies, but confirmation by real-world data is sparse. The aim of this study is to assess the effects on health care utilisation and costs in the elderly using real-world data on both, outpatient and inpatient care. Methods Retrospective community-based cohort study with 138,877 individuals aged ≥ 60 years, insured in a large health insurance fund in Thuringia (Germany). We assessed health care utilisation and costs due to influenza- or pneumococcal-associated diseases, respiratory infections, and sepsis in 2015 and 2016. Individuals were classified into four groups according to their vaccination status from 2008 to 2016 (none, both, or either only influenza or pneumococcal vaccination). Inverse probability weighting based on 236 pre-treatment covariates was used to adjust for potential indication and healthy vaccinee bias. Results Influenza vaccination appeared as cost-saving in 2016, with lower disease-related health care costs of − €178.87 [95% CI − €240.03;− €117.17] per individual (2015: − €50.02 [95% CI − €115.48;€15.44]). Cost-savings mainly resulted from hospital inpatient care, whereas higher costs occurred for outpatient care. Overall cost savings of pneumococcal vaccination were not statistically significant in both years, but disease-related outpatient care costs were lower in pneumococci-vaccinated individuals in 2015 [− €9.43; 95% CI − €17.56;− €1.30] and 2016 [− €12.93; 95% CI − €25.37;− €0.48]. Although we used complex adjustment, residual bias cannot be completely ruled out. Conclusion Influenza and pneumococcal vaccination in the elderly can be cost-saving in selective seasons and health care divisions. As cost effects vary, interpretation of findings is partly challenging.

Costs and Factors Associated with Hospitalizations Due to Severe Influenza in Catalonia (2017–2020)

“…Total mean costs were statistically significant higher for unvaccinated patients (EUR 12,002.56) than those vaccinated (EUR 10,650.66). This result coincides with Storch et al (2021), who found cost-saving effects for influenza vaccination in hospitalized cases [ 14 ]. In addition, ICU admission was statistically significant higher in the unvaccinated than in vaccinated patients.…”

Einmal geimpft, immer geimpft? Routinedatenanalyse zur wiederholten Influenzaimpfung von ≥ 60-Jährigen

“…Datengrundlage bildeten die Abrechnungsdaten der AOK Plus zu Thüringer Versicherten ≥ 60 Jahre aus dem vom Bundesministerium für Bildung und Forschung geförderten Verbundprojekt „Impfen60+ – Impfbereitschaft 60+ fördern“ (Förderkennzeichen: 03ZZ0819B; [ 15 ]). Diese Abrechnungsdaten dienten in der Primärstudie der gesundheitsökonomischen Evaluation der Influenza- und Pneumokokkenimpfungen [ 16 ] sowie der Analyse der Impfeffekte hinsichtlich der Krankheitslast [ 17 ] und unterlagen daher definierten Einschlusskriterien (siehe Onlinematerial).…”

Recent changes to adult national immunization programs for pneumococcal vaccination in Europe and how they impact coverage: A systematic review of published and grey literature

“…Before the latest expansion of the German NIP in 2016 to include more coverage for elderly and at-risk individuals, two records estimated low overall VCRs with PCV13 in immunocompromised adults (4.4%) 94 and elderly people (3.2%). 100 However, after the change in NIP, more recent studies estimated a higher coverage rate for both sequential vaccination (9.9% who received PCV13+PPV23) as well as for PPV23 vaccination (35.1%) in the at-risk population. 76 Similarly higher VCRs were estimated in older populations after the German change in NIP (PPV23: 39%, 76 50% [ 74 ; PCV13: 38%; 74 overall: 30.3% 111 ].…”