Effectiveness and cost of influenza vaccine reminders for adults with asthma or chronic obstructive pulmonary disease.

To assess the effectiveness and cost of interactive voice response (IVR) reminders for influenza vaccination compared with postcards, among adults with asthma or chronic obstructive pulmonary disease (COPD).Pragmatic, 3-arm, randomized control trial.The trial was conducted in an integrated healthcare organization during 2012 and 2013, using an existing IVR system. All adults aged 19 through 64 years with asthma or COPD (n = 12,285) were randomized to receive 1 of the following vaccination reminders: 1) postcard reminder only, 2) IVR reminder only, or 3) postcard plus IVR reminder. The primary outcome was influenza vaccination by October 31, 2012; the secondary outcomes were influenza vaccination by December 31, 2012, and by March 31, 2013.For subjects receiving an IVR call, 57% received a message on their answering machine; 27% answered the call; and 16% were not reached. Influenza vaccination rates were 29.5%, 31.1%, and 30.6% in the postcard-only, IVR-only, and postcard-plus-IVR study arms, respectively. After controlling for relevant covariates, IVR reminders were not significantly more or less effective than postcard reminders. Program costs were $0.78, $1.23, and $1.93 per subject for postcard-only, IVR-only, and postcard-plus-IVR reminders, respectively. Extrapolating costs to the entire population at the study site that typically receives influenza vaccination reminders (approximately 100,000 individuals), reminder costs would have been $0.55, $0.05, and $0.60 per subject for postcard-only, IVR-only, and postcard-plus-IVR reminders, respectively.IVR reminders are not more effective at promoting influenza vaccination than postcard reminders, but IVR reminders may be less expensive for large patient populations.