title: The cost of immunising at the general practice level.
abstract: BACKGROUND
  Childhood immunisation is one of the most cost-effective activities in health care. However, New Zealand (NZ) has failed to achieve national coverage targets. NZ general practice is the primary site of service delivery and is funded on a fee-for-service basis for delivery of immunisation events.
  
  
  OBJECTIVE
  To determine the average cost to a general practice of delivering childhood immunisation events and to develop a cost model for the typical practice.
  
  
  METHODS
  A purposeful selection of 24 diverse practices provided data via questionnaires and a daily log over a week. Costs were modelled using activity-based costing.
  
  
  RESULTS
  The mean time spent on an immunisation activity was 23.8 minutes, with 90.7% of all staff time provided by practice nurses. Only 2% of the total time recorded was spent on childhood immunisation opportunistic activities. Practice nurses spent 15% of their total work time on immunisation activity. The mean estimated cost per vaccination event was $25.90; however, there was considerable variability across practices. A 'typical practice' model was developed to better understand costs at different levels of activity.
  
  
  CONCLUSIONS
  The current level of immunisation benefit subsidy is considerably lower than the cost of a standard vaccination event, although there is wide variability across practices. The costs of delivery exceeding the subsidy may be one reason why there is an apparently small amount of time spent on extra opportunistic activities and a barrier to increasing efforts to raise immunisation rates.
authors.affiliation: Immunisation Advisory Centre, School of Population Health, The University of Auckland, PB 92019 Auckland New Zealand. n.turner@auckland.ac.nz
authors.forename: Nikki
authors.initials: N
authors.lastname: Turner
authors.forename: Paul
authors.initials: P
authors.lastname: Rouse
authors.forename: Stacey
authors.initials: S
authors.lastname: Airey
authors.forename: Helen
authors.initials: H
authors.lastname: Petousis-Harris
mesh_terms: D003362:Cost-Benefit Analysis; D017048:Health Care Costs / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D007114:Immunization / Q000191:economics* / Q000379:methods; D007223:Infant; D017059:Models, Econometric; D009520:New Zealand; D010346:Patient Care Management / Q000191:economics / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000191:economics* / Q000379:methods; D013997:Time Factors; D013996:Time and Motion Studies