title: School-located vaccination of adolescents with insurance billing: cost, reimbursement, and vaccination outcomes.
abstract: OBJECTIVE
  To assess, in a school-located adolescent vaccination program that billed health insurance, the program costs, the proportion of costs reimbursed, and the likelihood of vaccination.
  
  
  METHODS
  During the 2010-2011 school year, vaccination clinics were held for sixth- to eighth-grade students at seven Denver public schools. Vaccine administration and purchase costs were compared with reimbursement by insurers. Multivariate analyses were used to compare the likelihood of vaccination among students in intervention schools with students in control schools who did not participate in the program, with analyses stratified by grade (sixth grade vs. seventh-eighth grades).
  
  
  RESULTS
  Fifteen percent (466 of 3,144) of students attending intervention schools were vaccinated at school-located vaccination clinics. Among students vaccinated at school, 41% were uninsured, 37% publicly insured, and 22% privately insured. Estimated vaccine administration costs were $23.98 per vaccine dose. Seventy-eight percent of vaccine purchase costs and 14% of vaccine administration costs were reimbursed by insurers; 41% of total program costs were reimbursed. Sixth-grade students in intervention schools were more likely than those in control schools to receive tetanus-diphtheria-acellular pertussis (risk ratio [RR], 1.30; 95% confidence interval [CI], 1.08, 1.57), meningococcal conjugate (RR, 1.42; CI, 1.18, 1.70), and human papillomavirus (for females only, RR, 1.69; CI, 1.21, 2.36) vaccines during the 2010-2011 school year, with similar results for seventh- to eighth-grade students.
  
  
  CONCLUSIONS
  Although school-located adolescent vaccination with billing appears feasible and likely to improve vaccination rates, improvements in insurance coverage and reimbursement rates may be needed for the long-term financial sustainability of such programs.
authors.affiliation: Department of Pediatrics, University of Colorado Denver, Aurora, Colorado; Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado. Electronic address: matthew.f.daley@kp.org.
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Daley
authors.affiliation: Department of Pediatrics, University of Colorado Denver, Aurora, Colorado; Children's Outcomes Research Program, Children's Hospital Colorado, Aurora, Colorado; Colorado Health Outcomes Program, University of Colorado Denver, Aurora, Colorado.
authors.forename: Allison
authors.initials: A
authors.lastname: Kempe
authors.affiliation: Children's Outcomes Research Program, Children's Hospital Colorado, Aurora, Colorado.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pyrzanowski
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Tara M
authors.initials: TM
authors.lastname: Vogt
authors.affiliation: Children's Outcomes Research Program, Children's Hospital Colorado, Aurora, Colorado; Department of Family Medicine, University of Colorado Denver, Aurora, Colorado.
authors.forename: L Miriam
authors.initials: LM
authors.lastname: Dickinson
authors.affiliation: Colorado Health Outcomes Program, University of Colorado Denver, Aurora, Colorado.
authors.forename: Deidre
authors.initials: D
authors.lastname: Kile
authors.affiliation: Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, Colorado.
authors.forename: Hai
authors.initials: H
authors.lastname: Fang
authors.affiliation: Health Services Research, Denver Health, Denver, Colorado.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Rinehart
authors.affiliation: Department of Family Medicine, University of Colorado Denver, Aurora, Colorado; Denver Public Health, Denver, Colorado.
authors.forename: Judith C
authors.initials: JC
authors.lastname: Shlay
mesh_terms: D000293:Adolescent; D002648:Child; D003120:Colorado; D003365:Costs and Cost Analysis; D004180:Direct Service Costs; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000191:economics* / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics; D008297:Male; D012051:Reimbursement Mechanisms; D012572:School Health Services / Q000191:economics*
keywords: Adolescent; Billing; Cost; Immunization; Reimbursement; School; Vaccine