Objective: Quantify the value and cost-effectiveness of institution-subsidized childhood immunizations in a community health clinic setting.

Background: Child and adolescent immunizations are critical life-saving and cost-saving interventions, as the cost of treating vaccine-preventable diseases is greater than the cost of providing vaccination. Thus, the value of avoiding preventable disease in an integrated health system can offset the cost of implementing immunization programs. Additionally, vaccines have been shown to increase patient quality of life as measured by Quality-Adjusted Life-Years (QALYs), an economic estimate of the value of specific medical interventions. Vaccinations can generate QALYs at a lower cost than other interventions. We aimed to determine the cost-effectiveness of providing immunizations in a community health clinic to help clinicians, administrators, and policymakers advocate for institutional funding.

Methods: This retrospective study quantifies the value created—measured in QALYs—by providing reduced-cost immunization series for an underserved patient population in a community clinic and provides an estimate of institutional funds expended per QALY generated. A university-based community clinic provides primary care and immunizations to a marginalized and minoritized population. This clinic accepts private (15%) and public (75%) insurance and has an income-adaptive charge system for those who are uninsured (10%). Vaccinations provided by the clinic from 2019-2022 were quantified using Current Procedural Technology codes. Series completed during this period were measured in person-lifetimes by combining the lowest total fulfilled immunization schedules among all vaccinations collectively. Established Clinically Preventable Burden scores were utilized to determine the number of QALYs generated per vaccination series. These values were compared to the clinic's operational expenditures and cost per vaccine to estimate expenditures in US Dollars per QALY generated.

Results: From 2019-2022, the clinic had operational costs of $7,204,100. The clinic administered 26,419 vaccines falling under CDC recommendations for immunizations at a total cost of $161,308 (Table 1). Extrapolated over 18 years, these vaccinations represent 753 total completed lifetime vaccination series (excluding influenza vaccinations) for children and adolescents aged 0-18 years, estimated to have generated a minimum of 132 QALYs. The clinic generated these QALYs through a maximum estimated expenditure of approximately $11,600 per QALY.

Conclusions: Access to vaccinations decreases population disease burden and future associated costs. Medical institutions with large service areas and associated payers are uniquely positioned to improve their financial outcomes and the health of the populations they serve. Using clinic-based actual costs, the $11,600 per QALY generated is notably lower than previously published estimates for the total economic cost of providing vaccinations; current estimates suggest vaccination in adults involves costs of up to $39,000 per QALY for influenza vaccinations. These findings highlight a crucial opportunity for healthcare systems and payers to responsibly and sustainably expand critical services to underserved populations.