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Economic Analysis of a Child Vaccination Project Among Asian Americans in Philadelphia, Pa
Robert R. Deuson, PhD, MS, MSHS;
Kimberly Goodnow Brodovicz, MPH;
Lawrence Barker, PhD;
Fangjun Zhou, PhD, MS;
Gary L. Euler, DrPH, MPH
Arch Pediatr Adolesc Med. 2001;155:909-914.
Objective To ascertain the cost-effectiveness and the benefit-cost ratios of a
community-based hepatitis B vaccination catch-up project for Asian American
children conducted in Philadelphia, Pa, from October 1, 1994, to February
11, 1996.
Design Program evaluation.
Setting South and southwest districts of Philadelphia.
Participants A total of 4384 Asian American children.
Interventions Staff in the community-based organizations (1) educated parents about
the hepatitis B vaccination, (2) enrolled physicians in the Vaccines for Children
program, and (3) visited homes of children due for a vaccine dose. Staff in
the Philadelphia Department of Public Health developed a computerized database;
sent reminder letters for children due for a vaccine dose; and offered vaccinations
in public clinics, health fairs, and homes.
Main Outcome Measures The numbers of children having received 1, 2, or 3 doses of vaccine
before and after the interventions; costs incurred by the Philadelphia Department
of Public Health and the community-based organizations for design, education,
and outreach activities; the cost of the vaccination; cost-effectiveness ratios
for intermediate outcomes (ie, per child, per dose, per immunoequivalent patient,
and per completed series); discounted cost per discounted year of life saved;
and the benefit-cost ratio of the project.
Results For the completed series of 3 doses, coverage increased by 12 percentage
points at a total cost of $268 660 for design, education, outreach, and
vaccination. Costs per child, per dose, and per completed series were $64,
$119, and $537, respectively. The discounted cost per discounted year of life
saved was $11 525, and 106 years of life were saved through this intervention.
The benefit-cost ratio was 4.44:1.
Conclusion Although the increase in coverage was modest, the intervention proved
cost-effective and cost-beneficial.
From the National Immunization Program, Centers for Disease Control
and Prevention, Public Health Service, US Department of Health and Human Services,
Atlanta, Ga (Drs Deuson, Barker, Zhou, and Euler); and the Philadelphia Department
of Public Health, Philadelphia, Pa (Ms Brodovicz). Dr Deuson is now with Merck
& Co, Inc, Whitehouse Station, NJ; and Ms Brodovicz is now with Merck
Research Laboratories, Blue Bell, Pa.
Corresponding author and reprints: Robert R. Deuson, PhD, MS, MSHS,
Merck & Co, Inc, One Merck Dr, PO Box 100, Mail Stop WS1B-72, Whitehouse
Station, NJ 08889 (e-mail: robert_deuson{at}merck.com).
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