title: Hitting the Optimal Vaccination Percentage and the Risks of Error: Why to Miss Right.
abstract: OBJECTIVE
  To determine the optimal level of vaccination coverage defined as the level that minimizes total costs and explore how economic results change with marginal changes to this level of coverage.
  
  
  METHODS
  A susceptible-infected-recovered-vaccinated model designed to represent theoretical infectious diseases was created to simulate disease spread. Parameter inputs were defined to include ranges that could represent a variety of possible vaccine-preventable conditions. Costs included vaccine costs and disease costs. Health benefits were quantified as monetized quality adjusted life years lost from disease. Primary outcomes were the number of infected people and the total costs of vaccination. Optimization methods were used to determine population vaccination coverage that achieved a minimum cost given disease and vaccine characteristics. Sensitivity analyses explored the effects of changes in reproductive rates, costs and vaccine efficacies on primary outcomes. Further analysis examined the additional cost incurred if the optimal coverage levels were not achieved.
  
  
  RESULTS
  Results indicate that the relationship between vaccine and disease cost is the main driver of the optimal vaccination level. Under a wide range of assumptions, vaccination beyond the optimal level is less expensive compared to vaccination below the optimal level. This observation did not hold when the cost of the vaccine cost becomes approximately equal to the cost of disease.
  
  
  CONCLUSIONS
  These results suggest that vaccination below the optimal level of coverage is more costly than vaccinating beyond the optimal level. This work helps provide information for assessing the impact of changes in vaccination coverage at a societal level.
authors.affiliation: Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Harvey
authors.affiliation: Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America.|Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, United States of America.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Prosser
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Messonnier
authors.affiliation: Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America.
authors.forename: David W
authors.initials: DW
authors.lastname: Hutton
mesh_terms: D003141:Communicable Diseases; D003365:Costs and Cost Analysis; D004198:Disease Susceptibility; D006801:Humans; D008962:Models, Theoretical; D057766:Policy; D012307:Risk Factors; D014611:Vaccination / Q000191:economics / Q000706:statistics & numerical data*