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Vaccination Programs: Reducing Client Out-of-Pocket Costs

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What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a Community Guide systematic review completed in 2009 pdf icon [PDF - 587 kB] (15 studies, search period 1997–2009) combined with more recent evidence (5 studies, search period 2009–2012).

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.

Context

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Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 502 kB].

The systematic review included 20 studies.

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

Summary of Economic Evidence

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 502 kB].

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

  • Two studies estimated intervention cost for influenza vaccinations.
    • One study estimated the intervention cost was $35 per person per year, resulting in $15,050 per life year saved.
    • One study estimated the intervention cost was $54 per person per year, or $114 per additional person vaccinated.
  • The third study used modeling to estimate the effect of eliminating out-of-pocket costs for vaccinations series given to children born in the state of Georgia during 2003. They estimated it would cost $222 per child and $3165 per additional vaccinated child.

Applicability

The CPSTF finding should be applicable to a wide range of client and provider populations and settings.

Evidence Gaps

Additional research and evaluation are needed to answer the following questions and fill existing gaps in the evidence base. (What are 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?

Study Characteristics

  • Included studies evaluated intervention effects on uptake of childhood vaccination series (3 studies), influenza (9 studies), pneumococcal (6 studies), hepatitis B (2 studies), and human papilloma virus (1 study).
  • Studies were conducted in a range of client and provider populations and settings.

Publications