Stephen J.LurieMD, PhD, Contributing EditorIndividualAuthor
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.
Fontanarosa PB, Meyerhoff AS, Jacobs RJ. Cost-effectiveness of Pneumococcal Vaccine. JAMA. 2000;284(4):440-441. doi:10.1001/jama.284.4.436