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Costs of Interventions to Increase Vaccination Coverage Among Children in the United States: A Systematic Review
Kai Hong1, Andrew J Leidner1, Yuping Tsai1
1Immunization Service Division, National Center for Immunization and Respiratory Diseases (NCIRD) (K Hong, AJ Leidner, Y Tsai, B-H Cho, and S Stokley), Centers for Disease Control and Prevention (CDC), Atlanta, Ga.
Insights
The cost of interventions to increase childhood vaccination coverage in the US varies widely. Provider feedback interventions were most cost-effective, while community-based interventions were most expensive.
Area of Science:
- Public Health
- Health Economics
- Preventive Medicine
Background:
- The Community Preventive Services Task Force (CPSTF) recommends effective interventions to boost vaccination coverage.
- Understanding the economic impact of these interventions is crucial for implementation.
Purpose of the Study:
- To systematically review the costs associated with interventions aimed at increasing vaccination coverage in US children and adolescents.
- To provide data on cost-effectiveness for different intervention strategies.
Main Methods:
- Systematic literature search of PubMed, EconLit, Embase, and Cochrane databases.
- Included peer-reviewed articles published between January 1, 2009, and August 31, 2019.
- Abstracted data on intervention type, costs, target population, and risk of bias; stratified results by intervention, vaccine, and age group.
Main Results:
- Thirty-seven studies were reviewed, revealing significant cost variability.
- Cost per child ranged from $0.10 to $537.38; incremental cost per vaccinated child ranged from $6.52 to $5,098.57.
- Provider assessment and feedback interventions showed the lowest median cost per child ($0.17), while community-based interventions had the highest median costs.
Conclusions:
- There is substantial variability in the costs of CPSTF-recommended vaccination interventions.
- Cost-effectiveness differs significantly across intervention types, highlighting the need for careful selection based on economic considerations.
Background:
The Community Preventive Services Task Force (CPSTF) has recommended several interventions that have been demonstrated to be effective at increasing vaccination coverage.
Objective:
Conduct a systematic review to examine the costs of interventions designed to increase vaccination coverage among children and adolescents in the United States.
Data Sources:
PubMed, EconLit, Embase, and Cochrane.
Study Eligibility, Participants, And Interventions:
Peer-reviewed articles from January 1, 2009 to August 31, 2019.
Appraisal And Synthesis Methods:
Studies were identified with systematic searches of the literature, reviewed for inclusion criteria, abstracted for data on intervention, target population, costs, and risk of bias. Cost measures were reported as costs per child in the target population, costs per vaccinated child, incremental costs per vaccinated child, and costs per vaccine dose administered. Results were stratified by intervention type, vaccine, and age group.
Results:
Thirty-seven studies were identified for full-text review. Across all interventions and age groups, the cost per child ranged from $0.10 to $537.38, and the incremental cost per vaccinated child ranged from $6.52 to $5,098.57. Provider assessment and feedback interventions had the lowest (median) cost per child ($0.17) and a healthcare system-based combined intervention with multiple components had the lowest (median) incremental cost per vaccinated child ($26.65). A community-based combined intervention with multiple components had the highest median cost per child ($537.38) and the highest median incremental cost per vaccinated child ($5,098.57).
Limitations:
A small number of included intervention types and inconsistent cost definition.
Conclusions:
There is substantial variability in the costs of CPSTF-recommended interventions.
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