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Increasing Appropriate Vaccination: Reducing Client Out-of-Pocket Costs for Vaccinations

Task Force Finding

The Community Preventive Services Task Force recommends interventions that reduce client out-of-pocket costs based on strong evidence of effectiveness in improving vaccination rates. The effectiveness of these interventions has been demonstrated:

  1. In children, adolescents, and adults
  2. In a range of settings and populations
  3. When applied in varying levels of scale from individual clinical settings to statewide programs to national efforts
  4. Whether used alone or as part of a multi-component intervention

Read the full Task Force Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.


Intervention Definition

Reducing out-of-pocket costs to families for vaccinations or administration of vaccinations can be implemented by paying for vaccinations or administration, providing insurance coverage, or reducing copayments for vaccinations at the point-of-service.

About the Systematic Review

The Task Force finding is based on evidence from a Community Guide systematic review published in 2000 (19 studies, search period 1980-1997) combined with more recent evidence (15 studies, search period 1997-2009). The systematic review was conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to increasing appropriate vaccination. It updates and replaces the previous Task Force finding for Reducing Client Out-of-Pocket Costs for Vaccinations.


Updated Review (search period 1997-2009)

Of the 15 additional studies identified in the updated search period, 11 provided common measurements of change in vaccination rates.

  • Median increase in vaccination rates:
    • Overall: 22 percentage points (IQI: 6 to 33 percentage points; 11 studies)
    • Reducing client out-of-pocket costs alone: 28 percentage points (IQI: 2 to 47 percentage points; 6 studies)
    • Reducing client out-of-pocket costs with additional components: 20 percentage points (IQI: 6 to 20 percentage points; 5 studies)
    • Although the four remaining studies couldn't be combined with those above, they also showed increases in vaccination rates.
  • Reviewed studies evaluated the effectiveness of reducing client out-of-pocket costs in a range of different client and provider populations, healthcare settings, and for different vaccines.
Previous Review (search period 1980-1997)
  • Median increase in vaccination rates: 15 (Interquartile interval [IQI]: 2 to 29 percentage points; 13 studies)
  • Five studies provided different measures of change in vaccination rates with mixed results.

Economic Evidence

One study from the updated search period qualified for the economic review. Monetary values are reported in 2009 U.S. dollars.

  • The study modeled the effect of eliminating out-of-pockets costs for vaccinations to children born in the state of Georgia during 2003.
    • The estimated percentage of children who would have been up to date with their vaccinations increased from 78.4% to 85.4%.
    • Such a program would have cost $22.27 million for the 129,167 children born that year ($172.41 per child).

Publication Status

Full peer-reviewed articles of this systematic review will be posted on the Community Guide website when published. Subscribe External Web Site Icon to be notified when we post these publications or other materials. See our library for previous Community Guide publications on this and other topics.


The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.

Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Increasing appropriate vaccination: reducing client out-of-pocket costs for vaccinations. Last updated: MM/DD/YYYY.

Review Completed: October 2008