Projected Annual Costs and Savings Pertussis Booster Vaccine Requirement for by richman6

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									                 Projected Annual Costs and Savings
      Pertussis Booster Vaccine Requirement for School Entry in
                             California

      Estimated Annual State Costs                       Estimated Annual Savings
  (including additional ADA funds to schools for
            improved pupil attendance)

             $1.4 – 2M per year                                 $12M per year



A. Estimated annual costs of requiring pertussis vaccination for school entry

               Reimbursement for record checks by school staff1:
$<550,000      7th grade check (permanent)
$<440,000      optional 12th grade check (temporary catch-up provision for 5 years)

               Vaccine cost for indigent children – federally purchased by Vaccines for Children
$ 0            (VFC) Program

               Medi-Cal vaccine administration fees for children who would have only been
               vaccinated because of school entry requirement2:
$<300,000      7th graders (permanent)
$<200,000      optional 12th grade check (temporary catch-up provision for 5 years)


B. Estimated annual benefits of requiring pertussis vaccination for school entry

$12,000,000 Direct and indirect cost savings3, which include
$400,000    Medi-Cal direct cost savings4

               Additional avoided costs for schools and local health departments in not having
               to respond to >3700 cases (mailings, phone calls, home visits) of pertussis in
               grade 7-12 students in order to prevent transmission to peers and families


C. Estimated annual cost to State and benefit to schools from preventing absenteeism

$580,000       additional attendance funding (“ADA”) to schools for avoided absences from
               pertussis in 7-12 grade students5




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NOTES

1) --The reimbursement to schools during the 2003-2004 school year for checking vaccination in 7th graders was
approximately $1.10 per dose (California State Controller’s Office,
http://www.sco.ca.gov/ard/local/locreim/manuals/schooldistricts1205.pdf).
--Only 1 dose of the pertussis booster vaccine would be needed for students from grades 7-12.
--There were ~500,000 students in Grade 7 in California in 2003-2004.
--There were ~400,000 students in Grade 12 in California in 2003-2004.
(California Department of Education, http://www.cde.ca.gov/ds/sd/cb/sums03.asp)
                                                   th
              $1.10 x 1 x 500,000 = $550,000 per 7 grade class
                                                     th
              $1.10 x 1 x 400,000 = $440,000 per 12 grade class
These estimates are elevated, as private schools are usually not reimbursed for checking vaccination for their
students.

2) --At least half of Medi-Cal recipients would be estimated to receive the pertussis booster vaccination without a
school-entry requirement, while fewer than a half would be immunized because of it.
--The reimbursement of pertussis booster vaccine administration to Medi-Cal recipients in $9.00, half of which ($4.50)
is paid by State funds and half by Federal funds.
--There were ~500,000 students in Grade 7 in California in 2003-2004 (see note 1).
--27% of 12-year-olds in California were Medi-Cal eligible in 2003:
          769,440 persons aged 10-14 years were Medi-Cal eligible in 2003
          (Rand California, http://ca.rand.org/stats/health/medi-calzip.html).
          2,821,729 persons aged 10-14 years resided in California in 2003
          (California Department of Finance, Demographic Research Unit,
          http://www.dof.ca.gov/HTML/DEMOGRAP/Data/DRUdatafiles.asp).
--There were ~400,000 students in Grade 12 in California in 2003-2004 (See note 1).
--23% of 17-year-olds in California were Medi-Cal eligible in 2003:
          585,619 persons aged 15-19 years were Medi-Cal eligible in 2003 (Rand California, see above).
          2,579,680 persons aged 15-19 years resided in California in 2003 (California DOF, see above).
                                                                       th
               0.5 x $4.50 x 500,000 x 0.27 = $300,000 or less per 7 grade class
               0.5 x $4.50 x 400,000 x 0.23 = $200,000 or less per 12th grade class

3) --Universal adolescent booster immunization in the U.S. is estimated to save approximately $100 million annual
savings direct and indirect costs (Purdy et al., Clin Infect Dis. 2004;39:20-28).
--12% of the U.S. population resides California. (U.S. Census Bureau, 2005
http://www.census.gov/popest/states/NST-ann-est.html).
              $100 million x 0.12 = $12,000,000 annual savings in California

4) --$12 million annual estimated savings in California (see note 3).
--12% of estimated savings in adolescent pertussis vaccination attributable to direct medical costs (Purdy et al., Clin
Infect Dis. 2004;39:20-28).
--27% of 12-year-olds in California were Medi-Cal eligible in 2003 (see note 2).
               $12,000,000 x 0.12 x 0.27 = $400,000 annual Medi-Cal savings

5) --The annual incidence of pertussis in persons aged 10-19 in recent years in the US has been 130 per 100,000 or
higher (CDC, http://www.bt.cdc.gov/coca/ppt/10).
--There were ~2,900,000 students in grades 7-12 in California in 2003-2004
(California Department of Education, http://www.cde.ca.gov/ds/sd/cb/sums03.asp).
--The mean days missed by adolescents due to pertussis in Massachusetts was 5.5 days
(Lee et al., Clin Infect Dis. 2004;39:1572-80).
               130 x 29 x 5.5 = 20,735 days of school missed due to pertussis by 7-12 graders in California per
               school year
--ADA reimbursement reflects absences through April 15 of each school year, or about 140 days of 180 day school
year (School Fiscal Services Division, California Department of Education).
               20,735 days x (140/180) = 16,130 days missed up to April 15
--Average ADA reimbursement per pupil-year = $~5,000 (School Fiscal Services Division, California Department of
Education).

Loss of annual ADA reimbursement from in 16,130 days from 2,900,000 7-12 graders =
          [2,900,000 – ((2,900,000 x 140) – 16,130) /140)] x $5,000 = $580,000




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