Universally Recommended Vaccinations: Reducing Client Out-of-Pocket Costs for Vaccinations

Task Force Finding & Rationale Statement

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.

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; and (4) whether used alone or as part of a multi-component intervention.

Rationale

In 1997 the Task Force found strong evidence of effectiveness for interventions that reduce out-of-pocket costs. Based on the findings of this update, the Task Force reaffirms their original recommendation.

The previous review (1980-1997) identified 19 studies. Summary effect estimates were determined from 15 study arms in 13 studies. The overall median absolute increase in vaccination rates was 15 percentage points, with an interquartile interval (IQI) of 2 to 29 percentage points. Six study arms evaluated reducing client out-of-pocket costs when implemented alone (median absolute increase of 10 percentage points), and 9 study arms examined reducing client out-of-pocket costs as part of a multi-component strategy (median absolute increase of 16 percentage points).

Fifteen additional studies (1997–2007) were identified for the 2007 update. Eleven studies provided a common measurement of change in vaccination rates. Their overall median absolute increase in rates was 22 percentage points (IQI: 6 to 33 percentage points). Six studies examined the impact of reducing client out-of-pocket costs alone (median absolute increase of 28 percentage points) and 5 studies examined reducing client out-of-pocket costs as part of a multi-component strategy (median absolute increase of 20 percentage points).

The reviewed studies evaluated the effectiveness of interventions that reduce client out-of-pocket costs in a range of client and provider populations and settings. 

No evidence of harms was identified in either the 1997 or 2007 review.

The results indicate that reducing client out-of-pocket costs remains an effective intervention option for consideration in a wide range of clinical settings and populations. In the United States, the ability of health care systems and providers to implement these interventions may depend on the adequacy and timeliness of reimbursement for the costs of the vaccines, storage, and administration.