The 37th National Immunization Conference of CDC

Monday, March 17, 2003 - 11:42 AM

Who pays what: Cost of Vaccinating HCW with Smallpox in the US under S-1VP

Ismael R. Ortega-Sanchez, National Immunization Program, ESD, OD, Center for Disease Control, 1600 Corporate Square Boulevard, M/S E-61, Atlanta, GA, USA and Ben Schwartz, NIP, ESD, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, GA, USA.

Smallpox Vaccine, Cost Analysis, HCW Vaccination

To prepare for a possible bioterrorism attack the Advisory Committee on Immunization Practices (ACIP) recommends smallpox (vaccinia) vaccine to protect health care workers (HCW) who would care for a case of smallpox. The pre-event Stage 1 Vaccination Program (S-1VP) may include a half million HCW. Among the leading issues surrounding this recommendation are the economic impact of smallpox vaccination and the identification of major stakeholders.

To estimate the costs of S-1VP using a societal perspective and to identify potential “payers.”

We defined the sequence of activities and costs related to S-1VP by type of payer; estimated direct and indirect costs of vaccination including vaccine-related adverse events; and changed key variables to estimate cost ranges and perform sensitive analyses. Results are described per vaccine and million vaccinated. Payers include federal and state government, the health care system (HCS) and vaccinees.

About 31% of total costs of vaccination are from work or leisure time lost by enrollees, 36% program enhancements and management, 16% productivity impact of vaccine-related adverse effects, 3% monetary travel costs of vaccinees, 3 % medical treatment of smallpox vaccine complications, and 9% screening and vaccine associated costs. We estimate that the 36% of the cost will be paid by the HCW’s themselves, 20% by the HCS, 30% by the states and 14% by HHS-CDC. The percentage of costs burned by HCWs/HCS is higher when considering possible administrative leave costs.

From the societal as well as vaccinee and health-care system perspectives the economic impact of smallpox vaccination is sizable compared to some current vaccines. Among the cost components, indirect costs constitute the major part. Likewise, monetary expenses (e.g. travel cost, OTC, etc) and productivity losses (e.g., temporal disability, permanent disability and premature death) constitute an unavoidable economic burden to vaccinees.

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