Wang et al conduct a case study of the Massachusetts Essential School Health program to demonstrate the cost-benefit of school health services delivered by full-time registered nurses. See also the editorial by Taras.
To evaluate the effect of adverse events associated with live attenuated influenza vaccine (LAIV) in children younger than 5 years on the cost-effectiveness of influenza vaccination.
A decision analytic model was developed to predict costs and health effects of no vaccination, vaccination with LAIV, and vaccination with inactivated influenza vaccine (IIV). Probabilities, costs, and quality adjustments for uncomplicated influenza, outpatient visits, hospitalizations, deaths, vaccination, and vaccine adverse events were based on primary and published data. The analysis included the possible increased incidence of adverse events following vaccination with LAIV for children younger than 5 years, including fever, wheezing, and hospitalization. A societal perspective was used. Sensitivity analyses, including probabilistic sensitivity analysis, were conducted.
Vaccination in the physician office setting in the United States.
Hypothetical cohorts of healthy children aged 6 months to 4 years.
Vaccination with LAIV or IIV.
Incremental cost-effectiveness ratio in dollars per quality-adjusted life-year (QALY).
Cost-effectiveness ratios ranged from $20 000/QALY (age 6-23 months) to $33 000/QALY (age 3-4 years) for LAIV and from $21 000/QALY to $37 000/QALY for IIV for healthy children aged 6 months to 4 years. Inclusion of possible new adverse events for LAIV had varying effects on cost-effectiveness results. Results were not sensitive to the inclusion of wheezing as an adverse event but were sensitive to a possible increase in the probability of hospitalization.
Live attenuated influenza vaccine had comparable cost-effectiveness compared with IIV for children younger than 5 years under a wide range of assumptions about the incidence of adverse events.
This randomized clinical trial evaluates the costs and cost-effectiveness of collaborative care vs usual care for treatment of adolescent major depressive disorder in primary care settings.
This cost-effectiveness analysis estimates the cost-effectiveness of universal and targeted newborn congenital cytomegalovirus screening programs vs no screening among infants in US postpartum care and early hearing programs.
This study of Medicaid claims data examines the consistency of primary care within an accountable care organization that enrolled a pediatric Medicaid population.
This Viewpoint recommends that the research model for the Children’s Oncology Group be emulated to study the effects of inhaled nitric oxide in neonates to establish acceptable practice patterns and lower the economic burden on the US health care system.
This cohort analysis reports that total direct medical expenses for privately insured adolescents who incur the highest costs are associated with medical complexity, mental health conditions, and obesity.