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July 26, 2000

Cost-effectiveness of Pneumococcal Vaccine

Author Affiliations

Stephen J.LurieMD, PhD, Contributing EditorIndividualAuthor

JAMA. 2000;284(4):440-441. doi:10.1001/jama.284.4.436

To the Editor: Dr Lieu and colleagues1 describe the cost-effectiveness of 4 doses of pneumococcal conjugate vaccination in healthy infants, yet understate vaccination program costs and reach a troubling conclusion.

The authors' assumption of a $5 cost to administer each dose fails to reflect the amount actually paid in either public or private sectors. We believe a more accurate amount is $11.92, reflecting $5 for the 22% of children who are eligible for Medicaid and receive vaccines at public health clinics,2 $9.15 for the 16% of children who are eligible for Medicaid and receive vaccines from private providers (the newborn population-weighted average of state Medicaid reimbursement amounts3), and $15.09 for other children who receive vaccines in the private sector.4 Using this more realistic estimate would increase the vaccination program's societal net costs by nearly 60%, from $172 million to $274 million.

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