Sustainability of school-located influenza vaccination programs in Florida |
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| Affiliation: | 1. College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States;2. Florida Department of Health in Alachua County, Gainesville, FL, United States;3. Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States;4. College of Medicine, University of Florida, Gainesville, FL, United States;1. Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, GA 30329, USA;2. Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya;1. Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO, United States;2. Division of General Internal Medicine, Denver Health, Denver, CO, United States;3. National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States;4. Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States;5. Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States;6. Office of the Associate Director for Communication, Centers for Disease Control and Prevention, Atlanta, GA, United States;1. Oxford University Clinical Research Unit and Wellcome Trust Major Overseas Programme, Vietnam;2. National Institute of Hygiene and Epidemiology, Hanoi, Vietnam;3. Center for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK;4. Department of Medical Microbiology, Radboudumc, Nijmegen, Netherlands;5. The University of Melbourne, Peter Doherty Institute for Infection and Immunity, Department of Microbiology and Immunology, Parkville, Victoria, Australia;1. Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan;2. Kitasato Institute for Life Sciences and Graduate School of Infection Control Sciences, Kitasato University, 5-9-1 Shirokane Minato-ku, Tokyo 108-8641, Japan;3. Department of Respiratory Medicine, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan;4. Department of Clinical Laboratory, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan;1. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;2. Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia;3. Department of Epidemiology and Biostatistics, University of Georgia, College of Public Health, Athens, GA, USA;4. Macha Research Trust, Choma, Zambia;5. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA |
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| Abstract: | ![]()
BackgroundSchool-located influenza vaccination (SLIV) programs are a promising strategy for increasing vaccination coverage among schoolchildren. However, questions of economic sustainability have dampened enthusiasm for this approach in the United States. We evaluated SLIV sustainability of a health department led, county-wide SLIV program in Alachua County, Florida. Based on Alachua's outcome data, we modeled the sustainability of SLIV programs statewide using two different implementation costs and at different vaccination rates, reimbursement amount, and Vaccines for Children (VFC) coverage.MethodsMass vaccination clinics were conducted at 69 Alachua County schools in 2013 using VFC (for Medicaid and uninsured children) and non-VFC vaccines. Claims were processed after each clinic and submitted to insurance providers for reimbursement ($5 Medicaid and $47.04 from private insurers). We collected programmatic expenditures and volunteer hours to calculate fixed and variable costs for two different implementation costs (with or without in-kind costs included). We project program sustainability for Florida using publicly available county-specific student populations and health insurance enrollment data.ResultsApproximately 42% (n = 12,853) of pre-kindergarten – 12th grade students participated in the SLIV program in Alachua. Of the 13,815 doses provided, 58% (8042) were non-VFC vaccine. Total implementation cost was $14.95/dose or $7.93/dose if “in-kind” costs were not included. The program generated a net surplus of $24,221, despite losing $4.68 on every VFC dose provided to Medicaid and uninsured children. With volunteers, 99% of Florida counties would be sustainable at a 50% vaccination rate and average reimbursement amount of $3.25 VFC and $37 non-VFC. Without volunteers, 69% of counties would be sustainable at 50% vaccination rate if all VFC recipients were on Medicaid and its reimbursement increased from $5 to $10 (amount private practices receive).Conclusions and relevanceKey factors that contributed to the sustainability and success of an SLIV program are: targeting privately insured children and reducing administration cost through volunteers. Counties with a high proportion of VFC eligible children may not be sustainable without subsidies at $5 Medicaid reimbursement. |
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| Keywords: | Influenza vaccination Immunization Insurance Cost School health services School-aged population |
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