October 14, 2016 Kim Krisberg 4Comment

Another day, another study on the benefit of vaccines. This time, it’s a study on the economic cost of vaccine-preventable diseases among U.S. adults — a cost that likely surpasses your wildest guesses.

Published this week in Health Affairs, the study found that vaccine-preventable diseases affecting adults cost the American economy $8.95 billion in 2015, with unvaccinated adults accounting for $7.1 billion of that total. To conduct the study, researchers examined the economic burden associated with 10 vaccines that protect against hepatitis A; hepatitis B; shingles (or herpes zoster); human papillomavirus (HPV); influenza; measles, mumps and rubella (MMR); meningococcal disease; pneumococcal disease; tetanus, diphtheria and pertussis (Tdap); and chickenpox.

They found that the majority of that economic burden, about 95 percent, was due to direct medical costs, including $5.9 billion for inpatient treatment and $2.4 billion for outpatient treatment. The remaining 5 percent of the total tab was attributed to productivity losses, i.e. wages lost while receiving medical care. The costliest vaccine-preventable disease was the flu, which accounted for 65 percent, or $5.8 billion, of the economic burden. Another 21 percent, or $1.9 billion of the calculated 2015 burden, was due to pneumococcal disease, and 9 percent, or $782 million, was due to shingles. Study authors Sachiko Ozawa, Allison Portnoy, Hiwote Getaneh, Samantha Clark, Maria Knoll, David Bishai, H. Keri Yang and Pallavi Patwardhan write:

Estimating the economic burden of vaccine-preventable diseases among adults is a first step toward understanding the benefits of increasing adult vaccine uptake in the United States. It highlights the need for US adults to better appreciate the value of vaccines to prevent economic burden. By highlighting the tremendous financial burden that unvaccinated individuals place on the economy and the health system, we hope that our estimates will spur creative policy solutions to reduce the negative externality or spillover effect, while preserving the autonomy of patients to make more informed choices.

The study found that economic costs varied by age groups as well. For example, among people ages 19 to 49, influenza represented the greatest economic burden, at 85 percent, followed by HPV, at 12 percent. For people ages 50 to 64, influenza again took the top spot, followed by shingles. And for adults 65 and older, flu was again in first place, followed by pneumococcal disease. According to the Centers for Disease Control and Prevention, only about 43 percent of U.S. adults got vaccinated against influenza during the 2014-2015 flu season.

About 76 percent, or 14.1 million, of vaccine-preventable disease cases examined in the study occurred among unvaccinated adults, with the economic burden attributable to unvaccinated adults totaling $7.1 billion in 2015.

“The positive health impacts of vaccination, including reduced mortality and morbidity, are recognized more often than the economic burden from people not getting vaccinated,” the study stated. “Estimating and considering the economic burden of adult vaccine-preventable diseases is necessary for public health spending decisions and for increasing adult uptake of vaccines in the United States.”

To request a full copy of the vaccine study, visit Health Affairs. To learn more about expanding access to adult vaccinations, visit the Adult Vaccine Access Coalition.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for nearly 15 years.

4 thoughts on “When adults forgo their immunizations, it costs the nation billions in care

  1. hmmmm…influenza.
    And what is the cost of inoculating a huge proportion of the population – *every single year* as a comparison to these costs of treatment?
    AND, what proportion of this supposedly “vaccine-preventable” influenza would *really* have been prevented by the relevant vaccination?

    I think the numbers need to be refined somewhat to become a bit more meaningful.

  2. Really, the study is very weak indeed. First, since some of the vaccines involved prevent only a fraction of disease – indeed, it has not yet been directly proven that Gardasil will ultimately prevent ANY cancers over a lifetime, though it seems likely – it simply cannot be honestly implied that all the costs of these diseases would vanish if only people were not so stoopid (or broke) as to fail to get all their booster shots. Tetanus, yes; flu, no. Flu is expensive, but some years, the flu vaccination gives very little protection, while its apparent side effect of increasing rates of other respiratory infections presumably remains unchanged. That’s why it’s been estimated that only one respiratory illness is prevented per 100 vaccinations. Is that cost-effective? I don’t know, but at least it’s not reasonable to pretend either that the costs of having every living person get annual flu shots would be negligible, or that all the costs of flu itself would go away if we just did that.

    Contrarily, some of the diseases in the study have very low costs only because of current vaccination levels. There’s not a lot of economic burden associated with measles or tetanus because there are effective vaccines (well, and these days the fact that too many Americans won’t get their hands dirty on a bet). It’s impossible for the authors to say how much money isn’t spent yearly on doctor visits for tens of thousands of nonexistent measles cases, but the savings are almost certainly higher (given the vaccine’s longer efficacy) than the savings from universal flu vaccination would be. Indeed, one might point out that the most expensive diseases in the study are those for which vaccinations are least efficacious.

  3. Jane @2: Regarding Gardasil, there was just a paper out in The Lancet in September looking at the real-world impact of HPV vaccination on rates of cervical cancer in Australia that found a significant (I think some new sites reported 50%) decrease in rates of cervical cancer.
    So there is fresh data out there. (Sorry, can’t get links to work today.)

  4. @ Jane

    That’s why it’s been estimated that only one respiratory illness is prevented per 100 vaccinations.

    If these estimations are derived from the Cochrane metastudy a few years back, a bit more context should be precised.
    If memory serves, they concluded that the rate of confirmed flu cases among the population is about 2 to 3 per 100, and that the flu vaccine cut this number to about 1 to 2 per 100, on average (a 60% efficiency – but yes, last year’s vaccine was much worse),
    So yes, if I got these numbers right, it may be that the vaccine will only prevent one infection among 100 people, but that’s one out of 2 or 3 which are going to happen.
    And if these 2 or 3 infections per 100 people are resulting in a $ 5.8 billion bill, cutting this number in half by vaccinating these 100 people may still be cost-effective.

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