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Systematic Review
The CPSTF recommends interventions that reduce client out-of-pocket costs based on strong evidence of effectiveness in improving vaccination rates. The effectiveness of these interventions has been demonstrated among children, adolescents, and adults, in a range of settings and populations, when applied in varying levels of scale from individual clinical settings to statewide programs to national efforts, and whether used alone or as part of a multi-component intervention.
This Task Force finding is based on evidence from a Community Guide systematic review completed in 2009 (15 studies; search period 1997 - 2009) combined with more recent evidence (5 studies, search period 2009 - 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.
Eleven studies provided a common measurement of change in vaccination rates and showed a median increase of 22 percentage points (IQI: 6 to 33 percentage points). Six studies examined the impact of reducing client out-of-pocket costs alone (median increase of 28 percentage points; IQI: 2 to 47 percentage points) and 5 studies examined reducing client out-of-pocket costs as part of a multi-component strategy (median increase of 20 percentage points; IQI: 6 to 20 percentage points). The nine qualifying studies that did not provide a common measurement of change also reported overall increases in vaccinations received or administered.
Included studies evaluated intervention effects on childhood vaccination series (3 studies), influenza (9 studies), pneumococcal (6 studies), hepatitis B (2 studies), and human papilloma virus (1 study). The reviewed studies evaluated the effectiveness of interventions that reduced client out-of-pocket costs in a range of client and provider populations and settings.
Policies adopted in the United States, including the Federal Vaccines for Children Program and the Affordable Care Act, have expanded access to many vaccines at reduced out-of-pocket cost. Barriers to expanded implementation of efforts include the adequacy and timeliness of reimbursement for the costs of vaccines, storage, and administration. In the United States, the ability of health care systems and providers to implement these interventions may depend on the adequacy and timeliness of reimbursement for the costs of the vaccines, storage, and administration.
This CPSTF concludes that additional research is needed to determine the effectiveness of reducing client out-of-pocket cost interventions to increase rates of recommended vaccinations for adolescents (e.g., HPV, meningococcal, influenza). In addition, the Task Force suggests additional research to determine if these interventions are effective options to increase receipt of annual influenza vaccinations. Future research should also examine whether reducing client out-of-pocket cost interventions are essential components of school-based vaccination programs and on-site vaccination programs in general.