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The economics of vaccination remain an important issue

VANCOUVER, British Columbia — 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 Walter A. Orenstein, MD, an Infectious Diseases in Children editorial board member who spoke at the 2010 Pediatric Academic Societies Annual Meeting this week.

The issue of financing has plagued vaccine providers for more than 20 years, Orenstein said. He cited a three-year measles resurgence in the early 1990s as a turning point for vaccine public policy, noting the medical community realized that failure to vaccinate was primarily to blame for the disease’s resurgence. Many of the affected children had seen medical providers but had not been vaccinated.

Physicians operating in private practices had begun referring at least some children to public clinics for immunization due to parent’s 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 (VFC) Program in 1993 as a result of the Omnibus Budget Reconciliation Act.

“What did the VFC fix? It fixed vaccine costs for eligible children at 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 federally-contracted prices and built a mechanism to incorporate new vaccines rapidly by 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. While in general, private insurers reimburse at higher rates than Medicaid, some practices still lose money both 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 explained, 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 (IPV) was recommended over oral polio vaccine (OPV), 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. #1630. Presented at: 2010 Pediatric Academic Societies Annual Meeting; May 1-4, 2010; Vancouver, British Columbia.