摘要：Objectives . We examined recent public-sector trends in childhood vaccine costs and estimated future costs. Methods . We used public-sector price data to calculate vaccine purchase cost per child for children aged 0 to 6 years from 1975 to 2001. We fit a linear regression model to historical data and then used it to project costs per child from 2002 to 2020, adjusted to 2001 US dollars. Results . Controlling for inflation, the cost of vaccine purchase per child climbed from $10 in 1975 to $385 in 2001. The cost of vaccine purchase in the year 2020 following recommendation of 7 additional vaccines is estimated to be $1225 per child (95% confidence interval = $891, $1559). Conclusions . The cost per child for recommended vaccines at public-sector prices may triple over the next 2 decades. These projections have implications for vaccine financing at federal and state levels. The use of vaccines has greatly reduced the morbidity and mortality attributable to several childhood diseases. 1 Childhood vaccinations remain some of the most favorable and cost-effective prevention strategies available. 2, 3 Federal and state programs help ensure delivery of the vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) to American Indian and Alaska Native children, as well as to children who have public health insurance (Medicaid or state child health insurance extensions of Medicaid), no health insurance, or insurance with incomplete vaccine coverage. 4 The federal Vaccines for Children (VFC) program purchases vaccines recommended by ACIP for administration to program-eligible children, currently approximately 35% of the national birth cohort, 5 at a cost that exceeded $500 million for fiscal year 2000. 4 State programs purchase and deliver vaccines to children besides those entitled to VFC-purchased vaccines, and receive funding through grants from the federal Section 317 (childhood immunization) program as well as from state appropriations. Overall, more than half of all childhood vaccine doses in the United States are purchased in the public sector. 4 The number of vaccines recommended for universal administration to children has climbed steadily in the past 15 years. 6– 18 As a result, federal and state governments bear a growing cost burden to vaccinate children. With the addition of pneumococcal conjugate vaccine (PCV) to the consensus vaccine schedule for childhood vaccinations in 2001, 6 the cost of purchasing vaccines for a child at public-sector prices nearly doubled. 19 Furthermore, recent Institute of Medicine (IOM) panels reported that several new vaccines may be recommended for children by 2020. 4, 20 The recent increases in vaccine purchase costs are a major concern for public-sector vaccination efforts, but the financial and programmatic implications of these projections for vaccine purchase costs in the public sector have not been well characterized. We conducted an analysis of trends in childhood vaccine costs in the public sector over the past 25 years, adjusting for inflation. We then used these historical data to estimate future costs for purchase of childhood vaccines in the public sector by 2020.
