School-Located Vaccination for Influenza: A Comprehensive Estimate of Program Costs

Background. School-Located Vaccination for Influenza (SLV-I) represents a potentially important means of increasing influenza vaccination among school-aged children without additional burden to students’ primary health care providers and families. SLV-I programs have been operating successfully in many U.S. school districts since the 2006-2007 influenza season. Following the success of SLV-I programs for the 2009 H1N1 influenza epidemic, SLV-I for seasonal influenza continued to be implemented in some areas. However, little is known about the full costs to implement SLV-I, including costs for planning, promotion, and billing health plans for payment.

Methods. In this study, we estimated the full cost of conducting school-located vaccination for influenza (SLV-I). Our estimates include clinic day operations costs as well as pre- and post-clinic costs from the perspectives of schools, health departments (HDs), and their partners. We solicited the participation of HDs that had conducted SLV-I clinics in at least 1 of 2 previous school years. We collected and analyzed SLV-I labor and non-labor cost data from a sample of schools and their partners (e.g., school districts) and from HDs that led the clinics and their partners (e.g., community vaccinators). Cost data were collected for SLV-I clinics held during the 2011–2012 school year. We estimated SLV-I costs per clinic and per dose administered for the first clinic held in each school. We report cost estimates from the school and HD perspectives. We also estimated total SLV-I costs, which were calculated as school and HD costs plus the value of any donated time or materials. Our estimates exclude vaccine costs paid by HDs, because these costs are likely to differ across schools, depending on the proportions of students that qualify to receive federally-funded vaccine (i.e., Vaccines for Children). In future analyses, we will also examine factors that may affect total SLV-I costs, such as school characteristics (e.g., free/reduced lunch percentage), school staff roles and attitudes about SLV-I, and SLV-I program characteristics (e.g., extent of SLV-I pre-clinic marketing and communications), while controlling for HD-level fixed effects. 

 Results. Our cost analysis used data from the 76 schools and 5 HDs for which we obtained complete data on costs and the number of doses administered in the first SLV-I clinics. Estimated costs were $1,720 per clinic and $22 per dose administered, excluding vaccine costs incurred by HDs. HDs bore 75% of total costs. Costs per dose administered declined as the number of doses administered in an SLV-I clinic increased. For clinics that administered fewer than 50 doses (n=32), the average cost per dose was $66, whereas for clinics that administered 50 or more doses, the average cost per dose was $17.

 Conclusions. The estimate of $22 per dose administered, excluding vaccine costs incurred by HDs, provides a comparator by which potential SLV-I clinic providers can judge whether SLV-I programming may be a worthwhile investment.