Appendix
The appendix tables included below present additional data used in analysis. These tables provide additional context for the analysis presented in the results section above.
Figure A1: Practice Vaccination Activities Workflowa,b in the Time-Motion Assessment
Notes:
a. This workflow includes only activities conducted directly with the patient and do not include admin activities such as entering data in the state immunization registry and processing billing. Admin costs were assessed in the practice manager survey.
b. The workflow for patients that did not go on to receive a vaccination includes only steps (1) and (2).
Table A1. Observed Number of Administered Vaccinations for Each Vaccine
Vaccine Adults Children
DTaP- Hep B- IPV (Pediarix)a 0 1
DTaP-IPV-Hib (Pentacel) a 0 5
DTaP-IPV (Kinrix) a 0 15
DTaP - 20
Hep A (Havrix, Vaqta) 2 29
Hep A/B (Twinrix) 1 0
Hep B (Engerix, Recombivax HB) 7 11
Hib 1 14
Influenza (IIV: Standard Dose) 1 0
MenACWY, MCV (Menactra, Menveo) 1 14
MenB-FHbp (Trumenba)b 0 2
MenB-4C (Bexsero)b 1 0
MMR 0 11
PCV13 (Prevnar)c 39 21
IPV (Polio) 0 9
PPSV23 (Pneumovax) 25 0
RV1 (Rotavirus) (Rotarix) - 13
Td (Tenivac) 6 3
Tdap (Boostrix, Adacel) 58 5
4vHPVd 1 3
9vHPVd 7 17
Varicella (Varivax) 0 12
Zoster (Zostavax) 4 -
Other 8 3
Unknown 4 2
Notes:
a. When conducting the time-motion assessment, Pediatrix, Pentacel and Kinrix were recorded as "combination vaccines." To obtain accurate accounting for these combination vaccines, we reviewed which vaccines were ordered and used by the practice in question. When no data was available, we assume the Kinrix vaccine was given.
b. When conducting the time-motion assessment, MenB-FHbp and MenB-4c were both recorded as "MenB." We used the same process as described in footnote a to obtain accurate counts.
c. When conducting the time-motion assessment, data collectors recorded a
"PCV13/PPSV23" vaccination. As this vaccination was only provided to children during our observations, we assume that the vaccine provided was PCV13.
d. When conducting the time-motion assessment, 4vHPV and 9vHPV were recorded as
"HPV." We used the same process as described in footnote a to obtain accurate counts.
Table A2. Mean Purchase Pricea per Vaccine, by Practice Type
Vaccine
All ($) Internal medicine ($)
Family medicine ($)
Community
Health Clinic ($) OBGYN ($) Pediatric ($)
DTaP- Hep B- IPV (Pediarix)
60
(51, 91) - 51
(51, 52) 91 - 56
DTaP-IPV-Hib (Pentacel) 71
(57, 123 62 81
(57, 123) - - 60
(58, 62) DTaP-IPV (Kinrix) 42
(37, 62) 37 39
(37, 46) 62 - 39
(37, 41) DTaP (Daptacel) 21
(17, 27) 21
(17, 26) 18 27 - 19
Hep A (Havrix, Vaqta) 40 (21, 77)
57 (50, 65)
36
(22, 50) - - 21
(21, 22) Hep A/B (Twinrix) 89
(75, 114) 78 (75, 80)
88
75, 114) - 112 -
Hep B (Engerix, Recombivax HB)
41 10, 191)
46 (38, 60)
52
(10, 146) - - 12
(11, 12)
Hib 22
(17, 31) 22 21
(17, 23) 31 - 20
(18, 22) IIV: High dose (Fluzone
High-dose)
38
(30, 47) - 38
(30, 47) - - -
IIV: Standard dose 20
(15, 36) - 23
(15, 36) 16 - 18
LAIV 27
(14, 39) - 39 - - 14
MenACWY, MCV (Menactra, Menveo)
102
(96, 121) 97 101
97, 106) 121 - 97
(96, 97)
MenB-FHbp 180 - - - - 180
(Trumenba)
MenB-4C (Bexsero)
127
(12, 140) -
121 (120, 121)
- - 140
MMR 65
(57, 83) 59 58
(57, 59) 83 82 60
(59, 60) PCV13 (Prevnar) 157
(129, 188)
149 (129, 159)
159 (150, 182)
188 - 155
151, 160)
Polio (IPV) 25
(19, 41) - 23
(20, 29) - - 30
(19, 41) PPSV23 (Pneumovax) 78
(68, 108) 74 75
(72, 77) 108 - -
RV1 (Rotarix) 91
(80, 138) 81 95
(80, 138) - - 82
Td (Tenivac) 30
(22, 47) 26 (23, 28)
30
(22, 47) 40 - -
Tdap (Boostrix, Adacel) 34 (29, 41)
32 (30, 36)
30
(29, 31) 41 38
(37, 40) 37 (34, 40) 4vHPV (Gardasil) 153
(139, 189)
147 143, 150)
145 (139, 151)
189 149 -
9vHPV (Gardasil9) 170 (160, 194)
169 (165, 172)
167 (160, 172)
-
179 (165, 194)
171 (169, 172) Varicella (Varivax) 117
(101, 174)
174
103 (101, 107)
141 - 105
(102, 108)_
Zoster (Zostavax) 189 (184, 198)
189 (184, 198)
190 (184, 197)
- - -
Notes:
a. Data on purchase price was reported in the provider survey. All currency values are in US2015$.
Table A3. Mean Minimum Paymenta per Vaccine Dose, by Practice Type
Vaccine Allb ($) Internal
medicineb ($)
Family medicineb ($)
Community
Health Clinicb,c ($) OBGYNb ($) Pediatricb ($)
DTaP- Hep B- IPV
(Pediarix) 80 (27, 84) - 84 27 - 76
DTaP-IPV-Hib (Pentacel)
97 (81,
117) - 105 (92-
117) - - 81
DTaP-IPV (Kinrix) 59 (41, 66) - 66 41 - 52
DTaP (Daptacel) 28 (10, 33) 33 26 10 - 23
Hep A (Havrix, Vaqta) 46 (25, 68) 65 (62, 68) 35 (31, 40) 25 - 31 Hep A/B (Twinrix) 98 (62,
102) 102 96 (91,102) 62 - -
Hep B (Engerix,
Recombivax HB) 49 (8, 90) 58 57 (25,90) 8 - 24
Hib 25 (7, 26) - 26 7 - 23
IIV: High dose
(Fluzone High-dose) 35 (34, 36) - 35 (34, 36) - - -
IIV: Standard dose 22 (18,26) - 22 (18,26) 20 - -
LAIV . - - - - -
MenACWY, MCV (Menactra, Menveo)
126(36,
163) - 137 (111,
163) 36 - 104
MenB-FHbp
(Trumenba) - - - -
MenB-4C (Bexsero) 129 - - 129 - -
MMR 64 (12, 79) - 70 (61, 79) 12 - 52
PCV13 (Prevnar) 164 (89,
176) 169 (168, 170) 154
(138,170) 89 - 176
Polio (IPV) 34 (6, 37) - 35 (33, 37) 6 - 33
PPSV23 (Pneumovax) 72 (8, 89) 71 (53, 89) 72 (67, 78) 8 - -
RV1 (Rotarix) 116 (81,
150) - 116 (81,
150) 96 - -
Td (Tenivac) 25 (6, 36) 17 29 (22, 36) 6 - -
Tdap (Boostrix,
Adacel) 36 (9, 48) 31 (31, 32) 43 (38, 48) 9 25 45
4vHPV (Gardasil) 149 (134,
168) 146 151 (134,
168) - - -
9vHPV (Gardasil9)
158 186 202 (195-
208) 172 183 175
Varicella (Varivax) 111 (10,
130) - 124 (118,
130) 10 - 85
Zoster (Zostavax) 215
(152,279) 152 279 - - -
Notes:
a. Data on minimum payment was reported in the provider survey. All currency values are in US2015$.
b. Parenthetical values represent the lowest and highest observed values by any provider office that reported payments for a particular vaccine. If only one provider office reported a value, no range is given.
c. Two community health clinics participated in the study, one small rural clinic and one large urban clinic. One clinic only reported the maximum payment and did not report the minimum payment.
Table A4. Mean Maximum Paymenta per Vaccine Dose, by Practice Type
Vaccine Allb ($) Internal
medicineb ($)
Family medicineb ($)
Community
Health Clinicb,c ($) OBGYNb ($) Pediatricb ($)
DTaP- Hep B- IPV
(Pediarix) 99 (78, 116) - 116 78 - 81
DTaP-IPV-Hib (Pentacel)
119 (96, 163) - 130 (96,
163) - - 98
DTaP-IPV (Kinrix) 75 (53, 92) - 92 65 (53, 78) - 54
DTaP (Daptacel) 31 (27, 39) 39 28 28 (27, 29) - 27
Hep A (Havrix, Vaqta) 58 (33, 76) 74 (73, 74) 44 (34, 55) 54 (32, 76) - 35 Hep A/B (Twinrix)
117 (106, 126) 106 122 (118,
126) 102 - -
Hep B (Engerix,
Recombivax HB) 60 (25, 125) 61 (58, 65) 77 (29,
125) 42 (25, 59) - 25
Hib 31 (26, 35) - 26 30 (26, 35) - 32
IIV: High dose (Fluzone
High-dose) 44 (42, 47) - 44 (42, 47) - - -
IIV: Standard dose 29 (25, 36) - 31 (25, 36) 27 (25, 29) - -
LAIV . - - - - -
MenACWY, MCV
(Menactra, Menveo) 132 (127, 135) - 134 127 (126, 127) - 135
MenB-FHbp (Trumenba) - - - -
MenB-4C (Bexsero) 177 - - 177 - -
MMR 82 (69, 110) - 90 (70,
110) 70 (69, 71) - 75
PCV13 (Prevnar)
182 (176,191) 178 (176,180)
187 (184,
191) 176 - 185
Polio (IPV) 40 (33, 51) - 43 (35, 51) 33 - 34
PPSV23 (Pneumovax)
93 (87, 109) 89 (88, 89) 99 (89,
109) 88 (87, 90) - -
RV1 (Rotarix)
101 (51, 150) - 101 (51,
150) 117 - -
Td (Tenivac) 38 (30, 50) 30 41 (33, 50) 33 - -
Tdap (Boostrix, Adacel) 59 (45, 93) 56 (53, 59) 58 (49, 67) 45 (45, 45) 93 49 4vHPV (Gardasil)
192 (185, 201) 193 (185, 201)
191 (186,
195) 193 - -
9vHPV (Gardasil9)
268 (195, 445) 196 244 (289,
199) 195 445 212
Varicella (Varivax)
139 (118, 180) - 152 (124,
180) 118 - 132
Zoster (Zostavax) 302 (216- 387) 216 387 - - -
Notes:
a. Data on maximum payment was reported in the provider survey. All currency values are in US2015$.
b. Parenthetical values represent the lowest and highest observed values by any provider office that reported payments for a particular vaccine. If only one provider office reported a value, no range is given.
c. Two community health clinics participated in the study, one small rural clinic and one large urban clinic. One clinic only reported the maximum payment and did not report the minimum payment.