News Release


UM-led study finds physician practices affected by high cost of Prevnar vaccine.

September 2, 2003 press release from the University of Michigan Health System and School of Public Health.

ANN ARBOR, Mich.— The high cost of the life-saving Prevnar vaccine for young children is affecting how doctors choose to provide it, and causing some to steer parents to public vaccination clinics, a new University of Michigan-led study finds.

While the vast majority of nearly 700 children’s doctors surveyed in the study are recommending the vaccine, which protects against bacterial meningitis and other diseases, almost one in three harbors concerns about the cost — especially if many children they see don’t have insurance that covers their shots.

The results are published in the September issue of Pediatrics by UM researchers and the Centers for Disease Control and Prevention. The findings have immediate implications for the parents of today’s toddlers, who may learn they have to pay out of pocket or travel to another location to get the $260, four-shot series that’s recommended for all children under age 2 by the CDC. Both options are sizable obstacles for many families, and may mean some children don’t get vaccinated.

"We need to make sure that our health delivery and vaccine financing systems do not work as a barrier to children receiving their immunizations," says Gary Freed, MD, MPH, a co-investigator of the study. Freed is a professor of health management and policy in the UM School of Public Health; he is also The Percy and Mary Murphy Professor of Pediatrics and Child Health Delivery and director general pediatrics in the School of Medicine. He directs the Children's Health Evaluation and Research (CHEAR) unit at the University of Michigan, where the study was conducted. CHEAR has a CDC grant to study vaccine issues.

The study results may foreshadow further problems and “fragmentation” of vaccination practices as other pricey but effective children’s vaccines come on the market, says lead author Matthew M. Davis, MD, MAPP, an assistant professor of pediatrics at the UM Medical School. Davis is a member of the UM’s CHEAR unit.

“Vaccines are some of the most cost-effective tools that we have for protecting children’s health,” Davis emphasizes. “Historically, they have been inexpensive and physicians have been willing to absorb the cost of stocking them or even providing them to underinsured patients. But the cost of Prevnar is eroding physicians’ efforts to provide it in their clinics. And in general, vaccines are becoming more like other medications on the market — ones that are expensive but have profound benefits.”

Prevnar’s effectiveness is not in question, says Davis: It prevents infections by Streptococcus pneumoniae bacteria that cause tens of thousands of potentially deadly bacterial meningitis and bloodstream infections each year, and untold millions of painful ear infections. That’s why parents have clamored to get kids vaccinated with Prevnar since its approval in the year 2000. New CDC data show that despite major shortages, 41 percent of children under age 3 had at least three doses of it by 2002.

But the new study shows that because of Prevnar’s unprecedented cost, many doctors — especially those in smaller practices or who see many children whose insurance doesn’t cover Prevnar — are reluctant to treat it like any other vaccine.

Ironically, Davis notes, children with private insurance are most likely to be affected by this trend.

Such children, whose parents’ employer-sponsored insurance plans may not cover Prevnar because of its cost, may be ineligible to receive the federally-funded vaccines provided at no cost to children with Medicaid, no insurance coverage or other qualifications under the CDC’s Vaccines for Children program. VFC vaccines can be given at doctors’ offices or public clinics.

Some states supplement VFC’s coverage by purchasing vaccine that doctors can administer to children in private insurance plans that don’t cover all vaccines, or to all children regardless of insurance status. But, Davis says, the high cost of Prevnar appears to be a hurdle for some states in the current budget crunch, and they have left it off their lists of subsidized vaccines.

This “patchwork” system of vaccine coverage was the subject of a recent Institute of Medicine report that called for more uniform coverage, partly on the basis of evidence from the UM CHEAR unit. The IOM report also advised Congress to require private insurance plans cover all CDC-recommended childhood vaccines, with a subsidy from the federal government.

For now, though, Davis recommends that parents with private insurance who have children who meet CDC recommendations for Prevnar call their insurers to ask whether the vaccine is covered.

A longer version of this press release can be found at: http://www.med.umich.edu/opm/newspage/2003/vaccinestudy.htm

Contact for more information: Kara Gavin, University of Michigan Health System Media Relations
Phone: (734) 764-2220
E-mail: UMHSmedia@med.umich.edu

© 2003 The Regents of the University of Michigan
Updated September 2, 2003