title: Cost of vaccine administration among pediatric practices.
abstract: OBJECTIVE
  The goal was to describe variable costs to providers of delivering childhood immunizations.
  
  
  METHODS
  We documented variable costs (costs that vary with the amount of services rendered), including time spent by pediatric staff members and physicians on immunization-related activities, as well as supply costs and medical waste disposal costs. Ten private pediatric practices in the Denver, Colorado, metropolitan area participated in the study. Among the 7 practices that provided us with payment data, 8 health plans were mentioned by > or = 2 practices. There were 37 different agreements between the health plans and practices for vaccine administration payments.
  
  
  RESULTS
  The total documented variable cost per injection (excluding vaccine cost) averaged $11.51, calculated from the following categories: nursing time, $1.71; billing services, $2.67; nonroutine services, $1.64; registry use, $0.96; physician time, $4.05; supplies, $0.36; medical waste disposal, $0.12. Nonroutine activities primarily included performing vaccine inventory and ordering, providing vaccination records to requesters, and answering parent telephone questions about vaccinations. With the use of a simulation model to compensate for the small number of participating practices, the calculated total variable cost per injection was $11.83. When 2 vaccines were administered, we compared the sum of the 2 payments with the sum of the 2 variable costs ($23.02). More than one third of the payment agreements (13 of 37 agreements) paid the practices less than the combined variable costs for 2 immunizations.
  
  
  CONCLUSIONS
  This study shows that the variable costs of vaccine administration exceeded reimbursement from some insurers and health plans.
authors: Department of Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, Colorado, USA.
authors: Judith E
authors: JE
authors: Glazner
authors: Brenda
authors: B
authors: Beaty
authors: Stephen
authors: S
authors: Berman
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003120:Colorado; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics; D005251:Fees, Medical / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D007223:Infant; D007349:Insurance, Health, Reimbursement / Q000191:economics; D008297:Male; D010372:Pediatrics / Q000191:economics*; D011216:Practice Management, Medical / Q000191:economics*; D011331:Private Practice / Q000191:economics; D014611:Vaccination / Q000191:economics*