Exploring the costs of a 13-valent pneumococcal conjugate vaccination program for home care patients

The city of Joensuu in Finland vaccinated 409 elderly home care patients with the 13-valent pneumococcal conjugate vaccine (PCV13) in autumn 2012. All home care patients were also eligible for a seasonal influenza vaccine. The objective of this retrospective real-world data cohort study was to evaluate whether the immunization intervention with PCV13 for home care patients was cost saving from the payer's (municipality's) perspective in terms of a return on investment (ROI).

This was a retrospective observational registry study. We used registry data from the regional Mediatri patient information system covering all North Karelian municipalities, including individual-level data for all health and social care service utilization, diagnoses and procedures. Home care patients and their use of services were followed for 2 years. Cost comparisons were based on two specifications: (1) pneumonia-related health care costs; and (2) total health care costs. We compared patients who had received both influenza and PCV13 vaccinations to patients only vaccinated against influenza.

The pneumonia-related costs in the PCV13-vaccinated group were 434 EUR lower and the total health care costs 3800 EUR lower per person, compared to the non-PCV13-vaccinated group (bootstrapped 95% CIs -1682-527 EUR and -8233-621 EUR, respectively). PCV13 vaccination was associated with a return on investment of 7 EUR per 1 EUR spent during the 2 year follow-up period when pneumonia-related costs were used as baseline. Probability of the positive return on investment was .715.

The results suggest that vaccinating home care patients could potentially be cost saving from the health care and service producer's perspectives. The uncertainty from the decision-making perspective was due to the large variation in individual costs.