摘要：Objectives. We estimated and compared total costs and costs per dose administered for 2 influenza A 2009 monovalent vaccine campaigns in New York City: an elementary school–located campaign targeting enrolled children aged 4 years and older, and a community-based points-of-dispensing campaign for anyone aged 4 years and older. Methods. We determined costs from invoices or we estimated costs. We obtained vaccination data from the Citywide Immunization Registry and reports from the community points of dispensing. Results. The school campaign delivered approximately 202 089 vaccines for $17.9 million and $88 per dose. The community campaign delivered 49 986 vaccines for $7.6 million and $151 per dose. At projected capacity, the school campaign could have delivered 371 827 doses at $53 each or $13 each when we excluded the value of in-kind resources. The community points of dispensing could have administered 174 000 doses at $51 each or $24 each when we excluded the value of in-kind resources. Conclusions. The school campaign delivered vaccines at a lower cost per dose than did the community campaign. Had demand been higher, both campaigns may have delivered vaccine at lower, more comparable cost per dose. The 2009 influenza A H1N1 pandemic raised important, practical questions about how to vaccinate large numbers of people quickly, especially during an emergency, and how to reach vulnerable populations such as children. To accomplish both of these objectives, the New York City Department of Health and Mental Hygiene (DOHMH) conducted one of the nation's largest efforts to deliver influenza A (H1N1) 2009 monovalent vaccine. This effort included an elementary school–located vaccination campaign for children enrolled at that school who were aged 4 years and older and a community-based, mass-vaccination, points-of-dispensing campaign that was initially targeted to people aged 4 to 24 years and pregnant women, then expanded to other priority groups, and finally opened up to anyone in the general population aged 4 years and older for the last weekend. In addition, vaccination was available through private providers, hospitals, community health centers, DOHMH clinics, and pharmacies. School-located vaccination offers a convenient alternative to medical clinics, especially for children who lack access to preventive care. 1,2 Reaching children is important because children play a critical role in influenza transmission, and improving vaccination coverage among children can lower illness in the population as a whole. 3–6 Organizing community points of dispensing is another way to quickly deliver vaccine to a large number of people and decrease burden on medical providers during an emergency. Despite the potential value of these vaccination approaches, no studies have compared the resources required to conduct them, because few situations have emerged to allow real-world testing of both approaches simultaneously. In the fall of 2009, DOHMH implemented both approaches to provide 2009 H1N1 vaccine in New York City. We estimated and compared the cost of administering vaccine through schools and community points of dispensing. We also examined how cost per dose would change if each campaign operated at projected capacity. This information can assist public health agencies in selecting approaches for vaccinating children and adults in both routine and emergency circumstances.
