Reducing medical service utilization by encouraging vaccines: Randomized controlled trial Original Research Article

Background Vaccination against influenza is associated with reductions in hospitalizations for heart disease, cerebrovascular disease, pneumonia, or influenza, and the risk of death from all causes during the influenza season. Design Randomized controlled trial. Participants All members enrolled in the Blue Cross Blue Shield Associationʹs Government Wide Service Benefit Program in the states of Oklahoma, Rhode Island, Kentucky, California, Arizona, Utah, and Colorado in October 2002. The sample size was 339,220 members. Intervention Two identical influenza/pneumonia direct mail marketing pieces that encouraged members to receive influenza and pneumococcal vaccinations. The study period was October 15, 2002 through March 15, 2003 when most influenza cases occur. Data were collected in July 2003 and analyzed during August 2003. Main outcome measures Administrative claims based on influenza/pneumonia inpatient admissions and emergency department (ED) visits. Results The intervention group experienced a 2.62% (p=0.010) higher rate of influenza vaccinations; 4.61% (p=0.080) higher rate of pneumonia vaccinations; 9.67% (p=0.136) lower rate of influenza/pneumonia inpatient admissions; and 22.64% (p=0.002) lower rate of influenza/pneumonia ED visits compared to the control group. The benefit-cost ratio (return on investment) from this intervention was estimated to be $2.21 per dollar spent. Conclusions Administrative claims data suggest that members respond to health plan mailings with an increase in influenza vaccination rates. Health plans can cost-effectively impact medical service utilization and vaccination rates by mailing information to their members.