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Vaccination Programs: Client or Family Incentive Rewards Archived Review


What the CPSTF Found

About The Systematic Review

The Task Force finding is based on evidence from a Community Guide systematic review published in 2000 (Briss et al., 3 studies, search period 1980-1997) combined with more recent evidence (3 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.

Summary of Results

Six studies with seven study arms qualified for the review. Most of the studies evaluated incentives used in combination with additional intervention components.

  • Overall change in vaccination rates: median increase of 8.5 percentage points (interquartile interval [IQI]: 6 to 18 percentage points; six studies, seven study arms)
  • Change in vaccination rates when incentive rewards were combined with additional interventions: median increase of 7.0 percentage points (range of values: 3 to 38 percentage points; five studies)
    • The contribution of incentive rewards to this increase could not be determined.

Summary of Economic Evidence

The updated economic review included nine studies. Monetary values are reported in 2009 U.S. dollars.

  • Incentives included small value lotteries, gift certificates, cash rewards, baby products, child care, maternity benefits, or a combination of these.
  • The median estimated cost per person was $29.07 (IQI: $11.43 to $238.45; 6 studies).
    • Mailed reminders with lottery programs were the least expensive.
    • One program that offered material incentives and included comprehensive outreach, home visits, or other activities was the most expensive. With this study removed, the median and IQI were $20.11 and $8.95 to $89.84, respectively.
  • The median estimated cost for each person who was up-to-date with recommended vaccinations was $60.40 (IQI: $17.58 to $171.32; 6 studies).
  • One study from Germany showed a cost-savings of $121 per person immunized for influenza over a two year period.


  • Client or family incentive rewards were effective in increasing vaccination rates when implemented in public health settings (e.g. public health clinics and urban community clinics). Several of these programs coordinated efforts with both public and private partners.
  • Incentive rewards were effective when delivered to adults (influenza) and families with children (childhood series).

Study Characteristics

Following are the types and values of incentive rewards used in the included studies.

Government payments

  • One time payment of $208 AUD and child care assistance (1 study: Australia)

Lottery prizes

  • Grocery vouchers ($50)
  • Monetary prizes ($175)

Gift cards

  • Baby products ($10)

Food vouchers and baby products

  • Combination of the above