KEYWORDS:
Monte Carlo, Simulation, Cost-Analysis, Reimbursement, Influenza, Vaccination

BACKGROUND:
Context: New recommendations from the Advisory Committee on Immunization Practices (ACIP) encourage physicians to provide influenza vaccination to all adults over the age of 50. This recommendation adds large numbers to the target population for influenza vaccine. However, little is known about the practice costs incurred while following this recommendation.

OBJECTIVE:
Objective: Determine the business costs of delivering influenza vaccinations.

METHOD:
Design: Mathematical model applied to a Monte Carlo simulation. Data included: a workforce composition questionnaire completed by office managers from a convenience sample of primary care offices and observations from a workflow study of patient-staff interactions during visits by patients eligible to receive influenza vaccinations.
Setting and participants: October 2001 through February 2002, family and internal medicine practices delivering influenza vaccine to adults in California, New Mexico and New York.
Main Outcome Measures: Labor, non-labor overhead, supply, and total costs determined by the model in which the parameters were bounded by the workforce composition observations. Costs are compared to Medicare reimbursement rates for influenza vaccinations.

RESULT:
Results: The model produces costs that range from a low average of $10.87 per shot in a mass, walk-in clinic to a high average of $57.01 per shot for a scheduled visit in an office with one or two physicians. Costs to physicians of delivering influenza vaccination generally exceed average Medicare reimbursement rates of $11.71 for 2001 and $11.10 for 2002.

CONCLUSION:
Conclusions: Practice expenses are covered only at mass, walk-in influenza vaccination clinics. Immunizing adults against influenza benefits individuals and society but creates un-reimbursed practice business expenses.

LEARNING OBJECTIVES:
To understand the gap between business costs and reimbursement rates.