New vaccines cost more

September 1, 2009

New vaccines show some potential in therapeutic application. Historically, vaccines have been used in the prevention arenas and priimarily for children.

"In recent years, there are examples of vaccines that have shown this potential, including Prevnar and Gardasil-medications that initially were for younger people but are now in wider use within older populations," according to Jagannath M. Muzumdar, doctoral candidate, College of Pharmacy, University of Minnesota, Minneapolis.

Vaccines are one of the most cost-effective achievements in medicine because they not only protect people who are immunized but also protect the spread of the disease, providing a herd immunity effect, according to Muzumdar. Payers almost unanimously provide coverage because of their cost-effectiveness. In fact, at press time, UnitedHealth Group said that it will cover the H1N1 vaccine for its members whose benefit plans cover vaccines and also cover the administration of the vaccine for members whose plans currently do not include immunizations.

"In this regard, one can expect to see an increasing number of preventive vaccines for illnesses ranging from H1N1 influenza, to ear infections, to even dental cavities, as well as classical infectious diseases such as hepatitis C, HIV and rotavirus," Dr. Poland says.

"If these vaccines follow suit with other types of therapeutic vaccines we've looked at, we expect that therapeutic lung cancer vaccines will be effective only in certain subgroups of lung cancer patients," says Randall Hulshizer, MS, MA, senior clinical writer of ECRI Institute's Health Technology Forecast. "But within those subgroups, they are likely to become a standard of care as adjuvant therapy for all stages of non-small cell lung cancer."

In addition, ECRI Institute expects an increase in life expectancy and quality for patients who respond well to the vaccines and a decrease in overall costs of treatment, as the vaccines might reduce side effects and the amount of chemotherapy or radiation needed.

There is some limited use of vaccines in cancer therapy and diabetes, according to James Cross, MD, head of national medical policy and operations at Aetna.

"The spend for vaccines could definitely increase as more are developed for either prevention or treatment of diseases," Dr. Cross says. "However, vaccines are probably the most effective and cost-effective way to manage disease that there is."

Like many insurers, Aetna follows the recommendations of the government or specialty societies on the use of vaccines for both children and adults. The plan covers vaccines under its medical benefit, managing the cost through appropriate use, and through negotiated rates for the vaccine itself, Dr. Cross says.