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Cost-Effectiveness Analysis of Influenza and Pneumococcal Vaccination for Hong Kong Elderly in Long-term Care Facilities
  1. Joyce H S You1,
  2. William C.W. Wong2,
  3. Margaret Ip1,
  4. Nelson L S Lee1,
  5. Suzanne C Ho1
  1. 1 The Chinese University of Hong Kong, Hong Kong;
  2. 2 University of Melbourne, Australia
  1. E-mail: joyceyou{at}


Background: To compare cost and quality-adjusted life-years (QALYs) gained by influenza vaccination with or without pneumococcal vaccination to elderly living in long-term care facilities (LTCFs).

Methods: Cost-effectiveness analysis based on Markov modelling over 5 years, from a Hong Kong public health provider¡¦s perspective, on a hypothetical cohort of LTCF residents aged „d65 years. Benefit-cost ratio (BCR) and net present value (NPV) of two vaccination strategies versus no vaccination were estimated. The cost and QALYs gained by two vaccination strategies were compared by Student¡¦s t test in probabilistic sensitivity analysis (10,000 Monte Carlo simulations).

Results: Both vaccination strategies had high BCRs and NPVs (6.39 and USD334 for influenza vaccination; 5.10 and USD332 for influenza plus pneumococcal vaccination). In base-case analysis, the two vaccination strategies were expected to cost less and gain higher QALY than no vaccination. In probabilistic sensitivity analysis, the cost of combined vaccination and influenza vaccination were both significantly lower (p<0.001) than no vaccination. Both vaccination strategies gained significantly higher (p<0.001) QALYs than no vaccination. The QALYs gained by combined vaccination was significantly higher (p=0.030) than influenza vaccination alone. The total cost of combined vaccination was significantly lower (p=0.011) than influenza vaccination.

Conclusion: Influenza vaccination with or without pneumococcal vaccination appears to be less costly with higher QALYs gained than no vaccination, over a five-year period, for elderly living in LTCFs from the perspective of Hong Kong public health organization. Combined vaccination was more likely to gain higher QALYs with lower total cost than influenza vaccination alone.

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