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The ICER of the very high intensity program remained below < $100,000/QALY across all parameter ranges tested except when the peak influenza vaccination rate achieved in the high and very high intensity program was, respectively, >73.5% or <76.8%.
The very high intensity program was most likely to be cost-effective at willingness-to-pay thresholds of greater than $21,000/QALY.
These differences are likely due to the very high intensity program resulting in more vaccinations than previous programs (influenza and PPSV together v. either vaccination alone) [ 11, 12].
Further, in one-way sensitivity analyses, the very high intensity program only became cost-prohibitive (>$100,000/QALY) at less likely values for two parameters.
The very high intensity program ($24,479/QALY) was preferred at willingness-to-pay-thresholds of both $50,000 and $100,000/QALY.
The ICER of the very high intensity program remained < $50,000/QALY across all parameter ranges tested except at less likely values for the PPSV or influenza vaccination rates achieved in the high or very high intensity programs or for the cost of the very high intensity program (Table 5).
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Heavily promoted "high intensity" programs like Insanity and P90X are popular with millions of Americans, including the vice-presidential candidate, Paul Ryan, who is said to be devotee of P90X.
The ICERs of the low, high and very high intensity programs were, respectively, $358, $9,397 and $24,479/QALY.
We assumed identical vaccination rate trajectories for the medium and high intensity programs, although with greater peak vaccination rate gains by year 3.
Higher scores indicate a higher intensity program.
In multivariable analyses, no association of training was observed in a high-intensity program with mechanical ventilation score (adjusted mean difference, -5.36; 95% CI, -20.7 to 10.0).
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