49 - Cost Projections for Universal Purchase of Pediatric Vaccines in Michigan, 2025

Publication Number: 3046.49

Roopa Darwar, University of Michigan, South Glastonbury, CT, United States; Angela Rose, University of Michigan Medical School, Ann Arbor, MI, United States; Acham Gebremariam, University of Michigan Medical School, Ann Arbor, MI, United States; Sarah L. Reeves, University of Michigan Medical School, Ann Arbor, MI, United States; Lisa Prosser, University of Michigan Medical School, Ann Arbor, MI, United States

Background: Modifications to recommendations issued by the United States (U.S.) Advisory Committee on Immunization Practices (ACIP) may affect the routine availability of pediatric vaccines eligible for federal insurance coverage, including the Vaccines for Children (VFC) program. In the absence of VFC coverage, states may consider covering the costs of these recommended vaccines for eligible children.

Objective: To quantify the number of pediatric vaccine doses eligible for inclusion in a potential state-level universal vaccine purchase model in 2025, using the state of Michigan as an example.

Design/Methods: Immunization doses administered to children aged 0–18 years in Michigan in 2024 were identified from the Michigan Care Improvement Registry (MCIR). Doses administered to non-residents and for vaccines not included in the July 2025 ACIP pediatric immunization schedule were excluded from the analysis. Consistent with census data, the pediatric population was assumed to remain static from 2024 to 2025. Vaccine formulations were aggregated into 19 antigen categories aligned with the national immunization schedule. Specific vaccine formulations not included in the U.S. Centers for Disease Control and Prevention (CDC) vaccine price lists were mapped to a broader antigen group. Cost projections were derived by applying CDC cost per dose information to the number of doses for each vaccine type for three pricing assumptions: (1) federal VFC contract price, (2) private sector price, and (3) their midpoint. Total projected vaccine costs (in 2024 US$) were estimated by antigen and age group (0–6 months, 7–23 months, 2–6 years, 7–12 years, 13–18 years) across pricing scenarios. Additional scenarios considered vaccine administration costs and subsets of recommended vaccines.

Results: In 2024, 3,136,389 vaccine doses were administered to children in Michigan. Of these, 37% (n=1,149,606) were designated as VFC-eligible doses. Annual projected VFC expenditures ranged from US$107.2 million (VFC price) to US$149.9 million (private sector price) with a midpoint of US$126.8 million. Pneumococcal conjugate vaccines, a four-dose series, comprised the largest share (26%) of costs among all antigens and 13% of total doses. Human papillomavirus vaccines for children aged 7–18 years comprised 6% of doses and 15% of total costs.

Conclusion(s): This analysis provides state-level budget projections of a universal vaccine purchase program and establishes a framework to inform similar initiatives in other jurisdictions. Such state-level initiatives could ensure comprehensive access to pediatric vaccines in the absence of a federal VFC program.