An Economic Evaluation of the 2009 Childhood and Adolescent Vaccination Schedule In the US

Background: The economics of the recommended childhood and adolescent vaccine schedule in the US, diphtheria, tetanus, and pertussis (DTaP), measles, mumps, and rubella (MMR), polio, hepatitis A, hepatitis B, haemophilus influenza B (Hib), varicella, pneumococcal, adolescent meningococcal, influenza, human papillomavirus (HPV) and rotavirus vaccines, has not been studied.

Objectives: To evaluate the economics of the current US childhood and adolescent vaccination schedule.

Methods: For each vaccine, estimates of the incremental direct medical costs due to vaccine-preventable disease were obtained from published literature. 2008-2009 vaccination coverage and 2009 prices were used to calculate vaccine costs. Estimates of lifetime costs (2009 USD) discounted at 3% per annum, were applied to a US birth cohort (4.3 million) assuming direct effects only. Incremental costs of the individual vaccines and the schedule as a whole were assessed. Cost-benefit ratios (CBRs) were calculated as the direct medical cost savings/ vaccination cost. The model evaluated completion of the schedule with an individual vaccine strategy (DTaP, MMR and single-disease vaccines) and with two different pentavalent strategies (DTaP, polio, Hib or DTap, polio, hepatitis B plus other vaccines).

Results: Regardless of how the current pediatric vaccine schedule was completed, annual savings ranged between $13.9 billion for the individual vaccine strategy to $14.5 – $14.7 billion for pentavalent strategies. The total cost of vaccination ranged from $6.1 – $6.2 billion for pentavalent strategies to $6.5 billion for the individual vaccine strategy while savings in direct medical costs totaled $20.6 – $20.9 billion and $20.4 billion, respectively. As individual vaccines, DTaP, MMR, polio, Hib and HPV were cost-saving, as were both pentavalent vaccines. CBRs ranged from 3.1 to 3.4 for all scenarios examined.

Conclusions:  The current US pediatric vaccine schedule is cost saving and provides more than $3 in cost savings from disease prevention for each dollar spent on vaccination. Use of combination vaccines increases the net savings.