{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T16:08:50Z","timestamp":1761581330681,"version":"3.37.3"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"11","funder":[{"name":"UAB National Research Services"},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Background. \u2003Although the increasing number of recommended immunizations is essential for patients infected with human immunodeficiency virus (HIV), the potentially uncompensated costs of expanded immunizations will present significant challenges for clinics and health systems serving HIV-infected patients.<\/jats:p>\n               <jats:p>Methods. \u2003We estimated costs of providing Gardasil, Prevnar, and Zostavax to eligible patients at a US Ryan White Part C academically affiliated HIV clinic in 2013. Clinic expenditures were calculated using vaccine price and administrative fees. Revenue was calculated using insurance reimbursement data for vaccination and administration. Three scenarios were used: 100% uptake of vaccines, adjusted uptake based on published rates, and adjusted reimbursement according to pre-Affordable Care Act (ACA) insurance status.<\/jats:p>\n               <jats:p>Results. \u20032887 patients (27% Medicare, 13% Alabama Medicaid, 26% Commercial, 34% Uninsured), received care with wide variation in immunization reimbursement ($0 to $210) by insurance and vaccine. The net yield (revenue minus expenditure) was calculated for each vaccine. Prevnar was most costly: annual net yield of \u2212$60 691. Provision of all 3 vaccines would lead to a net yield of \u2212$97 122. Adjusting for reduced uptake led to annual clinic losses of $44 119. Using pre-ACA reimbursement for immunization of the uninsured led to reduced clinic losses (\u2212$62 326), attributable to reimbursement via Ryan White funds.<\/jats:p>\n               <jats:p>Conclusions. \u2003A 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 one calendar year. 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.<\/jats:p>","DOI":"10.1093\/cid\/civ637","type":"journal-article","created":{"date-parts":[[2015,7,30]],"date-time":"2015-07-30T01:21:00Z","timestamp":1438219260000},"page":"1726-1731","source":"Crossref","is-referenced-by-count":8,"title":["Immunization Costs and Programmatic Barriers at an Urban HIV Clinic"],"prefix":"10.1093","volume":"61","author":[{"given":"Ellen F.","family":"Eaton","sequence":"first","affiliation":[{"name":"1 Infectious Disease"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrzej","family":"Kulczycki","sequence":"additional","affiliation":[{"name":"2 Ryals School of Public Health"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Saag","sequence":"additional","affiliation":[{"name":"1 Infectious Disease"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Mugavero","sequence":"additional","affiliation":[{"name":"1 Infectious Disease"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James L.","family":"Raper","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham 3"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2015,7,29]]},"reference":[{"key":"2024111411390618900_CIV637C1","first-page":"77","article-title":"Vaccinating HIV patients: focus on human papillomavirus and herpes zoster vaccines","volume":"15","author":"Koenig","year":"2013","journal-title":"AIDS Rev"},{"article-title":"HIV Infection and Adult Vaccination","year":"2014","author":"CDC","key":"2024111411390618900_CIV637C2"},{"key":"2024111411390618900_CIV637C3","doi-asserted-by":"crossref","first-page":"3159","DOI":"10.1016\/j.vaccine.2014.07.086","article-title":"Pneumococcal vaccination in people living with HIV","volume":"33","author":"Thornhill","year":"2015","journal-title":"Vaccine"},{"article-title":"Vaccines for Children Program","year":"2012","author":"CDC","key":"2024111411390618900_CIV637C4"},{"key":"2024111411390618900_CIV637C5","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1086\/344057","article-title":"Natural history and clinical management of anal human papillomavirus disease in men and women infected with human immunodeficiency virus","volume":"35","author":"Chin-Hong","year":"2002","journal-title":"Clin Infect Dis"},{"article-title":"Recommended Adult Immunization Schedule\u2014United States \u2013 2015","year":"2015","author":"CDC","key":"2024111411390618900_CIV637C6"},{"issue":"Rr-05","key":"2024111411390618900_CIV637C7","first-page":"1","article-title":"Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP)","volume":"63","author":"Markowitz","year":"2014","journal-title":"MMWR Recomm Rep"},{"key":"2024111411390618900_CIV637C8","doi-asserted-by":"crossref","first-page":"1595","DOI":"10.1016\/j.vaccine.2013.10.081","article-title":"HPV vaccines to prevent cervical cancer and genital warts: an update","volume":"32","author":"Dochez","year":"2014","journal-title":"Vaccine"},{"key":"2024111411390618900_CIV637C9","first-page":"300","article-title":"Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccination recommendations of the advisory committee on immunization practices","volume":"64","author":"Petrosky","year":"2015","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2024111411390618900_CIV637C10","first-page":"816","article-title":"Centers for Disease Control and Prevention (CDC). 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