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Mark A. Miller, MD; Roland W. Sutter, MD, MPH&TM; Peter M. Strebel, MBChB, MPH; Stephen C. Hadler, MD

JAMA. 1996;276(12):967-971.

Abstract
Objective.
—To evaluate the economic consequences of introducing inactivated poliovirus vaccine (IPV) into the routine vaccination schedule in the United States to reduce vaccine-associated paralytic poliomyelitis (VAPP).

Design.
—Cost-benefit and cost-effectiveness models were formulated to compare the current national 4-dose live attenuated oral poliovirus vaccine (OPV) schedule with a 4-dose IPV schedule or a sequential schedule of 2 doses of IPV followed by 2 doses of OPV. Model assumptions were derived from the National Health Interview Survey (1994), current prices for OPV and IPV, a Delphi panel, compensatory awards by the National Vaccine Injury Compensation Program, and published and unpublished reports.

Main Outcome Measures.
—Annual societal incremental cost relative to the current schedule for the cost-benefit model; cost per VAPP case prevented for the cost-effectiveness model.

Results.
—Changing to an IPV-only or a sequential schedule would cost $28.1 million and $14.7 million, respectively. The costs per case of VAPP prevented were estimated as $3.0 million and $3.1 million for each option, respectively. Outcomes were most sensitive to the number of additional visits that may occur to avoid multiple injections.

Conclusions.
—The introduction of IPV into the routine vaccination schedule would not be cost-beneficial at current vaccine prices and with the current compensation awards paid to VAPP cases. The analysis provides a range of costs that policymakers need to consider if they wish to prevent VAPP. Although these costs are higher than those of other public health prevention programs, they may be justified because VAPP continues to occur as a result of government-mandated vaccination policies in the absence of known wild poliovirus transmission in the United States.

Author Affiliations
From the Epidemiology and Surveillance Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Ga.

Footnotes
Reprints: Roland W. Sutter, MD, MPH&TM, National Immunization Program (E05), Centers for Disease Control and Prevention, Atlanta, GA 30333.

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