Computer-generated recall letters for underimmunized children: how cost-effective?

Area of Science:

• Public Health
• Health Services Research
• Pediatrics

Background:

• Childhood immunizations are crucial for public health.
• Ensuring timely vaccination coverage requires effective outreach strategies.
• Computerized tracking systems facilitate identification of children due for immunizations.

Purpose of the Study:

• To assess the effectiveness of computer-generated recall letters in increasing immunization rates.
• To evaluate the cost-effectiveness of using recall letters for overdue immunizations.
• To compare recall letters with other potential interventions in health maintenance organization (HMO) settings.

Main Methods:

• A randomized controlled trial was conducted with 20-month-olds overdue for the measles-mumps-rubella (MMR) vaccine.
• Parents were randomized to receive personalized recall letters or serve as a control group.
• Immunization status was tracked via a computerized system, supplemented by telephone surveys for non-compliant cases.

Main Results:

• Recall letters significantly increased MMR immunization rates by 24 months (54% vs. 35%, P = 0.001).
• A significant proportion of parents (62%) were unaware that an immunization was due.
• Cost-effectiveness analysis projected a modest increase in coverage from 86% to 90% at $4.04 per additional child immunized.

Conclusions:

• Computer-generated recall letters improve immunization rates for children overdue for vaccines.
• The cost-effectiveness of recall letters may be lower than anticipated.
• Further research should compare recall letters with alternative low-cost strategies like automated telephone reminders.