BACKGROUND:
Vaccines are one of the greatest achievements of biomedical science and public health, and represent one of the most effective tools for prevention of diseases. Numerous studies have demonstrated the cost savings and cost-effectiveness of childhood vaccines in the United States (US). To date, we know of no study that has examined the benefits and costs of the routine childhood immunization schedule using consistent methodology and assumptions.

OBJECTIVE:
To evaluate the economic impact of the routine United States (US) childhood immunization schedule, Diphtheria and tetanus toxoids and acellular pertussis(DTaP), tetanus and diphtheria toxoids (Td), Haemophilus influenzae type b (Hib) conjugate, inactivated poliovirus (IPV), measles, mumps, and rubella (MMR), and hepatitis B vaccines (HepB).

METHOD:
Decision-tree-based analysis was conducted of a hypothetical US birth cohort of 3,803,295 infants using population-based vaccination coverage, published vaccine efficacies, historical data on disease incidence before vaccination, and disease incidence reported during 1995-2000. Costs were estimated using both payers' (direct costs) 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 year 2001 dollars, and all costs and benefits in the future were discounted at a 3% annual rate. Net present value and benefit-cost ratios of routine immunization were evaluated.

RESULT:
Analyses showed that routine childhood immunization with DTaP, Td, Hib, IPV, MMR and HepB for the 2001 U.S. birth cohort was cost-saving from both payers' and societal perspectives, with net savings of $9.9 billion and $42.5 billion, respectively. The direct and societal benefit-cost ratios for routine childhood vaccination with these six vaccines were 5.8 and 17.7.

CONCLUSION:
Regardless of the perspective, the current routine childhood immunization with DTaP, Td, Hib, IPV, MMR and HepB results in substantial cost savings.

LEARNING OBJECTIVES:
understand the economic impact of immunization program and how an immunization program may be assessed using economic methodology.