Managing Healthcare Costs: immunizations

Today’s Managing Health Care Costs Indicator is $156 million

There are few services delivered by the health care system that save more money than they cost. Even among preventive health care services, we almost always spend more to deliver preventive services than we can save from future averted health care costs, even looking over a long time horizon. Mammograms, for instance, costs over $35,000 per quality adjusted life year saved.

There is one bright spot, though. That’s childhood vaccinations. While most health care is at best cost effective, meaning we save quality-adjusted life years for a reasonable price, vaccinations are frankly cost-saving. Each dollar spent the measles-mumps-rubella vaccine saves $13.

A measles epidemic in Boston last month created havoc in one of our largest office buildings last month –and measles, mumps rubella (German measles) and pertussis (whooping cough) epidemics that have started amongst the unvaccinated cost millions in excess medical costs not to mention lost productivity.

That’s why it’s especially depressing that the House GOP budget includes a $156 million cut in the childhood immunization program. This is a classic place where spending now saves later. And cutting now will increase the cost of health care not just in the distant future, but even this coming year.

There are a lot of places to save money in health care. Cutting funds for childhood immunizations isn’t one of them!

There has been a lot in the news recently about immunization. An infectious disease researcher just published a book about the myth that MMR (measles mumps rubella) vaccine causes autism. (Multiple studies have failed to show a connection, but it’s not possible to design a study that absolutely positively proves the lack of a relationship). This issue has even been covered by NPR’s This American Life (approximately minute 22 of broadcast) – and the emphasis has been on preventable disease suffered because parents refuse to immunize their children against contagious childhood diseases. “Herd immunity” is most important, so when children do not receive immunizations, the risk for other children (including those too young for vaccines) increases.

I’d like to bring up another issue – not as important as the 10 month old covered with measles pox – but important nonetheless. There are few medical interventions that actually save money. For instance, doing incremental mammograms is a good idea, but each additional “quality adjusted life year”(QALY) costs about $58,000 in the health care system. (Non-Harvard link here)

Immunizations are the exception to this rule – one of the few medical interventions which both saves money and improves care. It’s estimated that every $1 spent on an MMR vaccine prevents $21 in medical cost. (Non-Harvard Link Here)

That’s not the only reason we should aggressively vaccinate our children. But in a society seeking value from the health care system, there are few value propositions as compelling as pediatric immunizations.