Managing Healthcare Costs: vaccinations

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!

Today’s Managing Health Care Cost Indicator is 2.3 million

Double click to enlarge image. Last column header is "net medical costs per person per year"

That’s how many quality adjusted life years we could gain if we achieved 90% preventive care.

Maciosek and colleagues at Health Partners in Minneapolis performed a literature review and did economic forecasts and concluded that it would cost just $72 billion annually to achieve 90% adherence to preventive guidelines.

The authors estimate that we would save $62 billion dollars in preventable medical costs by dramatically increasing preventive care. Thus we could save 2.3 million quality adjusted life years for just $10 billion dollars, a measly 0.6% of total health care spending. (That’s a bit over $4000 per QALY – much better than most medical care!)

Honestly - there isn't a better deal around - and we should sign up.

But let's not lose track of where the savings really are in preventive care. Immunizations, counseling to use aspirin, smoking cessation, and a handful of other things save money. Immunizations in fact are genuinely cost saving, and are calculated to save $322 per person annually, while the entire bundle of preventive services saves only $48 per person.

So – we should approach immunizations as a public health imperative as well as a good deal. Some states (Massachusetts is one) have purchased childhood vaccine for all children regardless of income or health care coverage - and as a result achieve VERY high rates of immunization. In Massachusetts, funding for this program has been maintained temporarily year to year. Many states are cutting back on their vaccination programs because of declining state revenue.

There are very few genuinely cost saving therapies in health care – and even most preventive care just offers better outcomes at a reasonable price. Vaccinations are an exception. Let’s invest in them.