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The economics of vaccination remain an important issue
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Increasing costs of vaccines and vaccine administration, primarily as a result of new vaccines added to the routine immunization schedule in recent years, are major hurdles to maintaining and improving upon the success of the childhood and adolescent immunization program, according to a speaker at the 2010 Pediatric Academic Societies Annual Meeting.
“The childhood vaccination program in the U.S. has been one of the most successful prevention programs in the world, but it is in jeopardy unless financial barriers to immunization are eliminated,” said Walter A. Orenstein, MD, of the Bill & Melinda Gates Foundation.
The issue of financing has been plaguing vaccine providers for more than 20 years, Orenstein noted. The three-year measles resurgence (1989-1991) was a turning point for vaccine public policy. The medical community said failure to vaccinate was the cause of the resurgence. Many of the unvaccinated children had seen medical providers but were not vaccinated.
Physicians operating in private practices had begun referring at least some children to public clinics for immunization due to parents’ inability to pay the costs of vaccines and their administration, and, for various reasons, these children often went unvaccinated. The response to this dilemma was the Vaccines for Children Program established in 1993 as a result of the Omnibus Budget Reconciliation Act.
“What did the VFC fix? It fixed vaccine costs for eligible children (children on Medicaid, who are uninsured, and Alaska Natives and American Indians) at all participating providers and underinsured children served at federally qualified health centers,” Orenstein said. “It also took pressure off state budgets for Medicaid payment for vaccines at that time, gave states the right to purchase vaccines at federal contract prices and built a mechanism to incorporate new vaccines rapidly through breaking down financial barriers.”
The VFC, however, did not fix reimbursement of vaccine administration for eligible children as well as those served by other public or private financers, according to Orenstein. In general, private insurers reimburse at higher rates than Medicaid, but some practices still lose money on funds they receive for vaccine purchase, as well as financial support for vaccine administration.
Cost-effectiveness also remains a topic of discussion, Orenstein noted, especially as the Advisory Committee on Immunization Practices continually recommends new vaccines that usually lead to increases in the overall costs of vaccination.
Orenstein said, however, that the ACIP does have comprehensive guidance for economic studies that analyze the vaccine’s use from a societal perspective in terms of clearly identified interventions, strategies and time frames. Cost-effectiveness evaluation is a critical part of ACIP deliberations. Yet, cost-effectiveness, as measured by traditional techniques, is not the sole criterion for setting vaccine policy. For example, inactivated polio vaccine was recommended over oral polio vaccine because it is safer, even though the cost for each case of vaccine-associated paralytic polio prevented was about $3 million. Among other factors considered by the ACIP are health burden, vaccine efficacy, program feasibility and vaccine risks.
For more information:
- Orenstein WA. Recommendations for new vaccines, cost considerations, and vaccine financing: Does the ACIP have the right information, tools and experts? #1630. Presented at: 2010 Pediatric Academic Societies Meeting; May 1-4, 2010; Vancouver, British Columbia.