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Vaccination Programs: Client or Family Incentive Rewards


What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a Community Guide systematic review completed in 2011 (6 studies with 7 study arms, search period 1980–2009) combined with more recent evidence (1 study, search period 2009–2012). The finding updates and replaces the 2011 CPSTF finding for Client or Family Incentive Rewards pdf icon [PDF 510 KB].

This review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to increasing appropriate vaccination.


Incentive reward programs are distinct from interventions that increase access to vaccination services (e.g., providing transportation or child care, delivering vaccines free or at reduced cost to clients).

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 487 KB].

Seven studies were included in the systematic review.

  • Overall vaccination rates increased by a median of 8 percentage points.
  • Incentive rewards used alone led to similar changes in vaccination rates (8.5 and 9.0 percentage points; 2 studies).

Summary of Economic Evidence

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 487 KB].

Economic evidence indicates even small incentives can increase vaccination rates, and the reach can be substantial when incentives are provided within health plans.

Seven studies were included in the review (search period: 1980–2012). Monetary values are reported in 2013 U.S. dollars.

  • Median sample size: 774 (6 studies)
  • Median intervention cost per person per year: $372 (4 studies)
  • Cost estimates per additional vaccinated person ranged from $248 to $2,447.
  • Studies were conducted in the United States (4 studies), Germany (2 studies), and Australia (1 study).
  • Studies evaluated programs to address hepatitis B (4 studies), influenza (1 study), and childhood vaccination series (2 studies).
  • Incentives included gift certificates, cash awards, and substantial credits for child care and maternity benefits.


The CPSTF considers the evidence to be applicable to vaccinations for children and adults in a wide range of clinical and community settings, and for various types of incentive rewards.

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

  • How effective are client or family incentive rewards when used alone?
  • What is the relationship between the size of the incentive reward and intervention effectiveness? Are there potential thresholds for effectiveness?
  • How long do program effects last?
  • How effective are interventions on vaccination rates among adolescents, adults, or older adults?
  • How effective are interventions in communities with disparities in vaccination rates?

Study Characteristics

  • Studies evaluated use of client incentive rewards alone (2 studies) or in combination with additional interventions (6 studies).
  • Evaluated programs were conducted mostly in public health settings, although several involved coordinated efforts with public and private partners.
  • Targeted client populations included adults and families with children.
  • Vaccines delivered in the included studies were seasonal influenza (1 study); tetanus, diphtheria, pertussis (1 study); and vaccines recommended as part of the childhood series (5 studies).
  • The type of incentive reward offered to clients included government payments (i.e., of $208 Australian dollars and childcare assistance), lottery prizes (i.e., $50 grocery voucher or $175 in monetary prizes), gift cards (i.e., $10 for baby products), baby products, and food vouchers.