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Pricey vaccines for kids still public health bargains

Researchers say advance budgeting for the increased costs of childhood immunization is a wise move.

By Susan J. Landers, AMNews staff. Feb. 17, 2003. Additional information

Washington -- The cost of childhood vaccines has risen over the past 26 years from $10 per child in 1975 to $385 in 2001, and those costs could take a giant leap upward when vaccines now in the pipeline become available.

The cost per child for recommended vaccines at public-sector prices may triple over the next two decades, warned a new vaccine study published in the December 2002 American Journal of Public Health.

The study was done, not to question the cost effectiveness of vaccines, but to serve as a warning to policy-makers that they should make sure there is enough money in the coffers to continue to cover the price tags of these valuable public health tools.

"In the past, vaccines were less expensive, and there may have been some impression on the part of officials that they would remain inexpensive," said Matthew Davis, MD, the study's lead author and an assistant professor of pediatrics and communicable diseases at the University of Michigan Medical School in Ann Arbor.

"Our analysis suggests that vaccines may be more expensive in the future than they have been in the past," said Dr. Davis. "But that's not to say that they are no longer an excellent investment in our children's health."

As the number of recommended vaccines for children has grown over the years, the role of the state and federal governments in financing their purchase for children who were in danger of going without has also increased. Currently, state and federal programs buy more than half of the vaccines sold in this country.

The study by Dr. Davis and colleagues is the first analysis of vaccine cost trends to try to put some parameters around the possibilities of what lies ahead. It was inspired in part by the introduction in 2000 of the pneumococcal conjugate vaccine for children, marketed by Wyeth Pharmaceuticals as Prevnar.

The drug's cost, at about $46 per dose for four doses, is more than four times that of the DTaP series and was alone responsible for doubling the total cost of childhood vaccines.

The high cost of Prevnar is due, in part, to its inclusion of the seven most common serotypes that cause 80% of pneumococcal infections in very young children, said Margaret Rennels, MD, a professor of pediatrics at the University of Maryland School of Medicine in Baltimore. "So, unquestionably it is a more difficult vaccine to manufacture [than a vaccine] which is just one serotype."

Another factor driving up prices is the more stringent regulatory climate in which the new vaccines are being developed, said Dr. Rennels. "The paperwork, the regulatory requirements, the quality monitoring, the time to get something approved by an Institutional Review Board, the length of the consent forms, everything has gotten more and more complicated," she said.

While Dr. Davis' study focused on the costs of vaccines in the public sector, he noted that vaccines purchased in the private sector are usually at least 20% higher.

Worth every penny

Although vaccines may fall under heightened scrutiny by both public and private purchasers, their value can not be overestimated, said Louis Cooper, MD, interim director of National Network for Immunization Information and a past president of the American Academy of Pediatrics.

When asked about the high cost of vaccines, Dr. Cooper responds with additional questions. "How can the public and the profession be so distorted about the value of prevention compared to what they are willing to spend on treatment? Why is it we spend more on Claritin and Viagra than we do on vaccines?"

Dr. Cooper attributes the costs to the fact that there are more and better vaccines now available, and he believes there will be little or no change in the willingness of payers to continue to cover them. "People who make the health decisions at the federal and state levels know that vaccines are a bargain. There is nothing we do in medicine that matches the return on investment from our vaccines."

And despite the withdrawal of some manufacturers from the vaccine marketplace, there are new vaccines in the pipeline, including a nose spray influenza vaccine, a conjugate meningococcal vaccine and a combination conjugate meningococcal and pneumococcal vaccine, said Dr. Rennels.

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Copyright 2003 American Medical Association. All rights reserved.