The price of prevention. cost of recommended activities to improve immunizations.
OBJECTIVE
To calculate the cost structure of a suite of immunization improvement interventions recommended by the Centers for Disease Control and Prevention (CDC).


METHODS
A determination was made of the cost to clinics and agencies that implement a suite of CDC-recommended practice improvement interventions to fully immunize a child for diphtheria-tetanus-attenuated pertussis (DTaP), inactivated poliovirus (IPV), and measles-mumps-rubella (MMR) vaccines. Patient data were collected through chart analysis of 16-month-old children in clinics participating in this study's interventions between May 1997 and August 2000. The study began on October 1, 1996, and was funded for 5 years (until September 30, 2002).


RESULTS
Study calculations suggest that an additional $0.013/per patient per month would be needed to cover these activities.


CONCLUSIONS
Identifiable cost structures are associated with the practice improvement strategies recommended by the CDC. The method of implementation may be as important as the interventions themselves. Present compensation for immunization may not actually cover the cost of service provision, and it is unlikely to cover the costs of practice improvement, as described in this paper.
Fontanesi
John
J
Department of Pediatrics, Division of Community Pediatrics, University of California at San Diego, La Jolla, California, USA. jfontanesi@ucsd.edu
De Guire
Michelle
M
Kopald
David
D
Holcomb
Kathy
K
D002140:California; D002487:Centers for Disease Control and Prevention, U.S.; D002675:Child, Preschool; D017598:Efficiency, Organizational; D017048:Health Care Costs; D006302:Health Services Research; D006801:Humans; D017589:Immunization Programs / Q000191:economics* / Q000458:organization & administration / Q000592:standards; D011314:Preventive Health Services / Q000191:economics*; D017749:Total Quality Management / Q000191:economics*; D014481:United States