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Cost-effectiveness of childhood immunization reminder/recall systems in urban private practices
L Franzini1, J Rosenthal, W Spears
1University of Texas Health Science Center at Houston School of Public Health, Houston, Texas.
Insights
Computerized telephone reminder systems are more cost-effective for increasing immunization rates in private practices than manual postcard systems. The autodialer system offers a lower cost per child and per extra immunization delivered.
Area of Science:
- Health Services Research
- Public Health Interventions
- Cost-Effectiveness Analysis
Background:
- Immunization reminder/recall systems are crucial for maintaining high vaccination coverage.
- Evaluating the economic efficiency of different reminder systems is essential for resource allocation in healthcare.
- The private sector plays a significant role in delivering primary care and immunization services.
Purpose of the Study:
- To compare the cost and cost-effectiveness of manual postcard versus computer-based telephone reminder/recall systems.
- To assess these systems within the context of private healthcare practices.
- To determine the most economically viable strategy for improving immunization rates.
Main Methods:
- A comparative study design was employed, contrasting a manual postcard system (mail) with a computer-based telephone system (autodialer) and a control group.
- Costs analyzed included direct expenses (equipment, supplies) and indirect costs (personnel time).
- Key metrics computed were cost per child, incremental cost relative to control, and cost-effectiveness ratios for return visits and immunizations delivered.
Main Results:
- The autodialer system demonstrated a lower average cost per child ($1.47) compared to the mail system ($2.28).
- Incremental visit costs were significantly lower for the autodialer group ($3.48) versus the mail group ($9.52).
- The autodialer system proved more cost-effective for delivering immunizations, with a cost of $4.06 per extra immunization compared to $12.82 for the mail system.
Conclusions:
- Excluding initial start-up expenses, the autodialer system is the most cost-effective reminder/recall method.
- When autodialer equipment costs are included, this system remains more cost-effective, particularly for larger medical practices.
- Automated telephone reminder systems offer a superior economic return for enhancing immunization delivery in private healthcare settings.
Objective:
To assess cost and cost-effectiveness of immunization reminder/recall systems in the private sector.
Methods:
A manual postcard system (mail) was compared with a computer-based telephone system (autodialer) and control. Costs included time costs and the cost of equipment and supplies. The cost per child and the incremental cost of the intervention relative to control were computed. Cost-effectiveness ratios were computed for return visits and for immunizations delivered.
Results:
The average cost per child was $2.28 for the mail group and $1.47 for the autodialer group. The incremental visit cost relative to the control was higher for the mail group ($9.52) than for the autodialer group ($3.48). The autodialer was more cost-effective in delivering immunizations: $4. 06 per extra immunization (autodialer) versus $12.82 (mail).
Conclusions:
Excluding start-up costs, the autodialer system was most cost-effective. Including autodialer equipment costs, the autodialer system is more cost-effective only for larger practices.