Effectiveness and cost-effectiveness of letters, automated telephone messages, or both for underimmunized children in a health maintenance organization - PubMed (original) (raw)

Clinical Trial

Effectiveness and cost-effectiveness of letters, automated telephone messages, or both for underimmunized children in a health maintenance organization

T A Lieu et al. Pediatrics. 1998 Apr.

Abstract

Background: Immunization rates have improved in the United States, but are still far from the national 90% goal for the year 2000. There is scant evidence about the effectiveness and costs of automated telephone messages to improve immunization rates among privately insured children.

Objective: To evaluate the effectiveness and cost-effectiveness of sending letters, automated telephone messages, or both to families of underimmunized 20-month-olds in a health maintenance organization (HMO).

Methods: In this randomized trial, underimmunized 20-month-olds identified by the HMO's computerized immunization tracking system were assigned to one of four interventions: 1) an automated telephone message alone; 2) a letter alone; 3) an automated telephone message followed by a letter 1 week later; and 4) a letter followed by an automated telephone message 1 week later. The primary outcome was receipt of any needed immunization by 24 months of age. Decision analysis was used to evaluate the projected cost-effectiveness of the alternative strategies.

Results: A total of 648 children were randomized. A letter followed by a telephone message (58% immunized) was significantly better than either a letter alone (44% immunized) or a telephone message alone (44% immunized). A telephone message followed by a letter (53% immunized) also was more effective than either alone, although the differences were not statistically significant. Among a similar comparison group that received no systematic intervention, 36% were immunized. The estimated cost per child immunized was 7.00usinglettersfollowedbyautomatedtelephonemessages,7.00 using letters followed by automated telephone messages, 7.00usinglettersfollowedbyautomatedtelephonemessages,9.80 using automated telephone messages alone, and 10.50usinglettersalone.Underalternativecostassumptionsforautomatedtelephonemessagesandmailedmessages,thecostperchildimmunizedrangedfrom10.50 using letters alone. Under alternative cost assumptions for automated telephone messages and mailed messages, the cost per child immunized ranged from 10.50usinglettersalone.Underalternativecostassumptionsforautomatedtelephonemessagesandmailedmessages,thecostperchildimmunizedrangedfrom2.20 to $6.50.

Conclusions: For underimmunized 20-month-olds in this HMO setting, letters followed by automated telephone messages were more effective and cost-effective than either message alone. The cost-effectiveness of automated telephone messages and letters may vary widely depending on the setting, and choices among strategies should be tailored to the populations being served.

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