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Estimating the Costs and Income of Providing Vaccination to Adults and Children

Yarnoff, Benjamin, PhD*; Kim, David, MD; Zhou, Fangjun, PhD; Leidner, Andrew J., PhD; Khavjou, Olga, MA*; Bates, Laurel, BA*; Bridges, Carolyn B., MD†,‡

doi: 10.1097/MLR.0000000000001117
Original Articles

Introduction: Vaccinations are recommended to prevent serious morbidity and mortality. However, providers’ concerns regarding costs and payments for providing vaccination services are commonly reported barriers to adult vaccination. Information on the costs of providing vaccination is limited, especially for adults.

Methods: We recruited 4 internal medicine, 4 family medicine, 2 pediatric, 2 obstetrics and gynecology (OBGYN) practices, and 2 community health clinics in North Carolina to participate in a study to assess the economic costs and benefits of providing vaccination services for adults and children. We conducted a time-motion assessment of vaccination-related activities in the provider office and a survey to providers on vaccine management costs. We estimated mean cost per vaccination, minimum and maximum payments received, and income.

Results: Across all provider settings, mean cost per vaccine administration was $14 with substantial variation by practice setting (pediatric: $10; community health clinics: $15; family medicine: $17; OBGYN: $23; internal medicine: $23). When receiving the maximum payment, all provider settings had positive income for vaccination services. When receiving the minimum reported payments for vaccination services, pediatric and family medicine practices had positive income, internal medicine, and OBGYN practices had approximately equal costs and payments, and community health clinics had losses or negative income.

Conclusions: Overall, vaccination service providers appeared to have small positive income from vaccination services. In some cases, providers experienced negative income, which underscores the need for providers and policymakers to design interventions and system improvements to make vaccination services financially sustainable for all provider types.

*RTI International, Research Triangle Park, NC

National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta

Berry Technology Solutions, Peachtree City, GA

This research was supported by funding (Contract # 200-2014-M-60317B) from the Centers for Disease Control and Prevention (CDC).

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Use of trade names and commercial source is for identification only and does not constitute endorsement by the US Department of Health and Human Services, or the US Centers for Disease Control and Prevention.

The authors declare no conflict of interest.

Reprints: Benjamin Yarnoff, PhD, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709. E-mail:

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