The effect of influenza and pneumococcal vaccination in the elderly on health service utilisation and costs: a claims data-based cohort study

Abstract

Background: To date, cost-effectiveness of influenza and pneumococcal vaccinations was assumed in several health economic modelling studies, but confirmation by real-world data is sparse. The aim of this study is to assess the effects on health care utilisation and costs in the elderly using real-world data on both, outpatient and inpatient care.

Methods: Retrospective community-based cohort study with 138,877 individuals aged ≥ 60 years, insured in a large health insurance fund in Thuringia (Germany). We assessed health care utilisation and costs due to influenza- or pneumococcal-associated diseases, respiratory infections, and sepsis in 2015 and 2016. Individuals were classified into four groups according to their vaccination status from 2008 to 2016 (none, both, or either only influenza or pneumococcal vaccination). Inverse probability weighting based on 236 pre-treatment covariates was used to adjust for potential indication and healthy vaccinee bias.

Results: Influenza vaccination appeared as cost-saving in 2016, with lower disease-related health care costs of - €178.87 [95% CI - €240.03;- €117.17] per individual (2015: - €50.02 [95% CI - €115.48;€15.44]). Cost-savings mainly resulted from hospital inpatient care, whereas higher costs occurred for outpatient care. Overall cost savings of pneumococcal vaccination were not statistically significant in both years, but disease-related outpatient care costs were lower in pneumococci-vaccinated individuals in 2015 [- €9.43; 95% CI - €17.56;- €1.30] and 2016 [- €12.93; 95% CI - €25.37;- €0.48]. Although we used complex adjustment, residual bias cannot be completely ruled out.

Conclusion: Influenza and pneumococcal vaccination in the elderly can be cost-saving in selective seasons and health care divisions. As cost effects vary, interpretation of findings is partly challenging.

Keywords: Claims data; Cost; Elderly; Health care utilisation; Influenza vaccination; Pneumococcal vaccination; Real-world data.

Fig. 1

Vaccination scheme for insurant inclusion. IV: individuals who were vaccinated against influenza in the third or fourth quarter of the years 2014–2016 and not vaccinated against pneumococci in 2008–2016, PV: individuals with an initial pneumococcal vaccination in 2014 and no influenza vaccination in 2012–2014. BOTH: individuals with an initial pneumococcal vaccination in 2014 and with influenza vaccination in the third or fourth quarter of the years 2014–2016. NONE: Individuals who were not vaccinated against influenza in 2012–2016 nor against pneumococci in 2008–2016 were included in the control group. To avoid bias due to long-term vaccination effects, we excluded individuals with an additional pneumococcal vaccination in 2016 from PV and BOTH. To rule out biased estimations of vaccine effectiveness due to prior vaccinations, we also excluded individuals with prior pneumococcal vaccination in 2008–2013 in all groups and with prior influenza vaccination in 2012–2013 in PV and NONE. Outcomes were observed for 2015 and 2016.

Fig. 2

Flowchart of the study population inclusion