OBJECTIVES: This study evaluated the economic impact of routine childhood immunization in the United States (US), which should be reassessed periodically as uptake, disease epidemiology, and recommendations change. Previous estimates did not include annual influenza immunization and impact of immunization on quality-adjusted life years (QALYs).
METHODS: Separate decision trees were used to model each of the 14 vaccine-preventable diseases covered by routine childhood immunizations (i.e., DTaP, Haemophilus influenzae type b, hepatitis A, hepatitis B, inactivated poliovirus, influenza, MMR, pneumococcal conjugate, rotavirus, and varicella immunizations). The 2017 US birth cohort was followed for their remaining lifetime, with the model calculating direct medical costs associated with routine immunization and cases of illness for a scenario with and without immunization (based on current and pre-vaccine era disease incidence estimates, respectively). For the societal perspective, the model also includes productivity losses associated with immunization (influenza only), cases of disease, and disease-related mortality. The model estimates discounted incremental cases, disease-related deaths, life years (LYs) lost, quality-adjusted life years (QALYs) lost, costs (2018 USD), and an overall benefit-cost ratio (BCR).
RESULTS: Across all vaccine-preventable diseases, routine childhood immunization resulted in the prevention of more than 18 million cases of disease, 12,000 deaths, 200,000 LYs lost, and 300,000 QALYs lost. Although the childhood vaccination program was associated with vaccination costs of nearly $8 billion from the direct medical cost perspective and over $9 billion from the societal perspective, these costs were fully offset by disease-related costs averted. Childhood immunization was associated with over $10 billion in averted direct medical costs (BCR > 2) and over $20 billion in averted societal perspective costs (BCR > 3).
CONCLUSIONS: Results from the current economic evaluation highlight the value of the childhood immunization program in preventing disease-related morbidity, mortality, QALY loss, and associated costs.
