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Economic Evaluation of the 7-Vaccine Routine Childhood Immunization Schedule in the United States, 2001
Fangjun Zhou, PhD;
Jeanne Santoli, MD, MPH;
Mark L. Messonnier, PhD;
Hussain R. Yusuf, MBBS, MPH;
Abigail Shefer, MD;
Susan Y. Chu, PhD, MSPH;
Lance Rodewald, MD;
Rafael Harpaz, MD, MPH
Arch Pediatr Adolesc Med. 2005;159:1136-1144.
Objective To evaluate the economic impact of the routine US childhood immunization schedule: diphtheria and tetanus toxoids and acellular pertussis; tetanus and diphtheria toxoids; Haemophilus influenzae type b conjugate; inactivated poliovirus; measles, mumps, and rubella; hepatitis B; and varicella vaccines.
Design Decision tree–based analysis was conducted using population-based vaccination coverage, published vaccine efficacies, historical data on disease incidence before vaccination, and disease incidence reported for 1995-2001. Costs were estimated using the direct cost and societal (direct and indirect costs) perspectives. Program costs included vaccine, administration, vaccine-associated adverse events, and parent travel and time lost. All costs were inflated to 2001 US dollars, and all costs and benefits in the future were discounted at a 3% annual rate.
Participants A hypothetical 2001 US birth cohort of 3 803 295 infants was followed up from birth through death.
Main Outcome Measures Net present value (net savings) and benefit-cost ratios of routine immunization.
Results Routine childhood immunization with the 7 vaccines was cost saving from the direct cost and societal perspectives, with net savings of $9.9 billion and $43.3 billion, respectively. Without routine vaccination, direct and societal costs of diphtheria, tetanus, pertussis, H influenzae type b, poliomyelitis, measles, mumps, rubella, congenital rubella syndrome, hepatitis B, and varicella would be $12.3 billion and $46.6 billion, respectively. Direct and societal costs for the vaccination program were an estimated $2.3 billion and $2.8 billion, respectively. Direct and societal benefit-cost ratios for routine childhood vaccination were 5.3 and 16.5, respectively.
Conclusion Regardless of the perspective, the current routine childhood immunization schedule results in substantial cost savings.
Author Affiliations: National Immunization Program, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services, Atlanta, Ga. Dr Yusuf is now with UNICEF, New Delhi, India.
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