We evaluated the economic impact of routine childhood immunization in the United States (US), reflecting updated vaccine recommendations and recent data on epidemiology and coverage rates.


An economic model followed the 2017 US birth cohort from birth through death; impact was modeled via a decision tree for each of the vaccines recommended for children by the Advisory Committee on Immunization Practices as of 2017 (with annual influenza vaccine considered in scenario analysis). Using information on historic prevaccine and vaccine-era incidence and disease costs, we calculated disease cases, deaths, disease-related healthcare costs, and productivity losses without and with vaccination, as well as vaccination program costs. We estimated cases and deaths averted due to vaccination, life-years (LYs) and quality-adjusted life-years (QALYs) gained due to vaccination, incremental costs (2019 US dollars), and the overall benefit-cost ratio (BCR) of routine childhood immunization from the societal and healthcare payer perspectives.


Over the cohort’s lifetime, routine childhood immunization prevented over 17 million cases of disease and 31,000 deaths; 853,000 LYs and 892,000 QALYs were gained. Estimated vaccination costs ($8.5 billion) were fully offset by the $63.6 billion disease-related averted costs. Routine childhood immunization was associated with $55.1 billion (BCR of 7.5) and $13.7 billion (BCR of 2.8) in averted costs from a societal and healthcare payer perspective, respectively.


In addition to preventing unnecessary morbidity and mortality, routine childhood immunization is cost-saving. Continued maintenance of high vaccination coverage is necessary to ensure sustained clinical and economic benefits of the vaccination program.

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Competing Interests

CONFLICT OF INTEREST DISCLOSURES: Justin Carrico, Sandra Talbird, and Claire Mellott are employed by RTI Health Solutions, which received funding for the conduct of this study. Elizabeth La was an employee of RTI Health Solutions when this study was conducted and is now an employee and shareholder in the GSK group of companies. Ya-Ting Chen, Cristina Carias, and Craig Roberts are employees of Merck Sharp & Dohme LLC., a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, and are shareholders in Merck & Co., Inc., Rahway, NJ, USA. Mawuli Nyaku was an employee of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, and a shareholder in Merck & Co., Inc., Rahway, NJ, USA, when this study was conducted. Gary Marshall has been an investigator on clinical trials funded by GlaxoSmithKline, Merck, Pfizer, Sanofi Pasteur, and Seqirus, and he has received honoraria from these companies for service on advisory boards and/or nonbranded presentations.