Vaccination Programs: Reducing Client Out-of-Pocket Costs

Related Pages

Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends interventions that reduce client out-of-pocket costs used alone or combined with additional interventions to increase vaccination rates among people of all ages in a range of settings and populations. This includes interventions for individual clinical settings, statewide programs, or national efforts.

The full CPSTF Finding and Rationale Statement and supporting documents for Vaccination Programs: Reducing Client Out-of-Pocket Costs are available in The Community Guide Collection on CDC Stacks.

Intervention

Reducing out-of-pocket costs to clients involves program and policy changes that make vaccinations or administration more affordable. Changes could include paying for vaccinations or administration, providing new or expanded insurance coverage, or lowering or eliminating patient out-of-pocket expenses at point-of-service (e.g., copayments, coinsurances, and deductibles).

About The Systematic Review

The CPSTF finding is based on evidence from a Community Guide systematic review completed in 2009 (15 studies, search period 1997-2009) combined with more recent evidence (5 studies, search period 2009-2012).

Study Characteristics

  • Evaluated intervention effects on uptake of childhood vaccination series (3 studies), influenza (9), pneumococcal (6), hepatitis B (2), and human papilloma virus (1)
  • Conducted in a range of client and provider populations and settings

Summary of Results

Twenty studies were included.

  • Overall vaccination rates increased by a median of 22 percentage points (11 studies)
    • Reducing out-of-pocket costs alone: increase of 28 percentage points (6 studies)
    • Reducing costs in combination with additional interventions: increase of 20 percentage points (5 studies)
  • All studies that did not provide common measure reported favorable results (9 studies)

Summary of Economic Evidence

Three studies were included (search period 1980-2012). Monetary values in 2013 U.S. dollars.

  • Two studies estimated intervention cost for influenza vaccinations:
    • $35 per person per year, resulting in $15,050 per life year saved (1 study)
    • $54 per person per year, or $114 per additional person vaccinated (1 study)
  • One study modeled eliminating out-of-pocket costs for childhood vaccination series: $222 per child and $3,165 per additional vaccinated child

Applicability

Findings applicable to a wide range of client and provider populations and settings.

Evidence Gaps

  • How effective are these interventions for adolescent populations?
  • Does reducing client out-of-pocket costs work to increase rates of annual influenza vaccinations?
  • Are these interventions an essential component of school-based vaccination programs or on-site vaccination programs in general?

Implementation Considerations and Resources

Policies adopted in the United States, including the Federal Vaccines for Children Program and the Affordable Care Act, have expanded access to many vaccines by reducing out-of-pocket costs for clients.

The ability of healthcare systems and providers to implement these interventions may depend on how well and how quickly they are reimbursed for the costs of vaccines, storage, and administration.

Crosswalks

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.