August 06, 2015
HIV clinics stand to lose a lot of money providing HIV-positive patients with recommended vaccinations, suggested a study published in the online Clinical Infectious Diseases.
“A cost analysis of 3 vaccines shows great variation in insurance coverage, with potential losses of almost $100,000 for one HIV clinic if eligible patients received vaccinations in 1 calendar year,” researchers reported.
The study looked at the cost of providing Gardasil, Prevnar, and Zostavax to eligible patients at a US Ryan White Part C academically affiliated HIV clinic in 2013. Of the 2887 patients deemed eligible for the vaccines, 34% were uninsured, 27% were covered by Medicare, 26% by commercial insurance, and 13% by Alabama Medicaid.
After calculating insurance reimbursement for each vaccine and comparing it with the clinic’s cost to purchase and administer it, researchers found that the clinic would lose $97,122 providing all 3 vaccines to eligible patients. Prevnar, in particular, was the most costly vaccine, posing an annual clinic loss of $60,691. By adjusting for reduced uptake of vaccines based on published rates, researchers saw the annual clinical losses drop to $44,119. Along the same lines, reimbursement via Ryan White funds for the immunization of patients without insurance reduced clinic losses to $62,326. Still, findings suggest that higher reimbursement rates are needed to support clinics in providing recommended vaccinations, researchers concluded.
“Adequate, cost neutral reimbursement should be instituted if medical providers and health systems are to achieve Advisory Committee on Immunization Practices immunization recommendations for both HIV positive and negative adults,” they wrote.—Jolynn Tumolo