Published online July 10, 2006
PEDIATRICS Vol. 118 No. 2 August 2006, pp. e251-e257 (doi:10.1542/10.1542/peds.2006-0114)

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Freed, G. L. Articles by Bradley, J. Search for Related Content PubMed PubMed Citation Articles by Freed, G. L. Articles by Bradley, J. Related Collections Infectious Disease & Immunity Social Bookmarking                         What's this?

ARTICLE

Use of a New Combined Vaccine in Pediatric Practices

Gary L. Freed, MD, MPH^a,b,c, Anne E. Cowan, MPH^a,b, Sarah J. Clark, MPH^a,b, Jeanne Santoli, MD, MPH^d and Joel Bradley, MD^e

^a Child Health Evaluation and Research Unit
^b Division of General Pediatrics
^c Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan
^d Centers for Disease Control and Prevention, Atlanta, Georgia
^e Premier Medical Group, Nashville, Tennessee

OBJECTIVE. On December 13, 2002, Pediarix, a combination vaccine that contains diphtheria, tetanus, acellular pertussis; hepatitis B; and inactivated polio vaccines, was licensed by the Food and Drug Administration for use in the primary immunization series. Use of this vaccine decreases the number of injections that children receive when completing their primary immunization series at the 2-, 4-, and 6-month well-child visits. The objective of this study was to determine the factors that influence the use of this combined vaccine in private pediatric practices, with particular attention to the perceived economic impact of Pediarix and actions taken to address this impact within the private pediatric setting.

METHODS. A mail survey study was conducted of a random sample of 565 practicing pediatricians that was obtained from the American Medical Association Masterfile. Frequency distributions were developed for all responses, and the vaccine financing policies of the state of practice for each respondent were determined. ² analysis was performed to assess any associations of the predictor variables with the outcome variables of interest, use or consideration of use of the Pediarix vaccine. Logistic regression was used to determine the independent association of the predictor variables with use or consideration of use of Pediarix. Regression models that did and did not include practice ownership as a predictor variable were developed.

RESULTS. Response rate was 63% (N = 355). A total of 39% (n = 123) of the respondents' practices were purchasing Pediarix for use with their private patients. An additional 18% (n = 55) were considering purchasing the vaccine. Those who were in practices that were owned by hospitals or health systems were more likely than those who were in solo or group practices to purchase Pediarix for their private patients. Approximately half of the remaining respondents order Pediarix through their state immunization program. Among the 52% of respondents who did not, 23% reported that the vaccine was not yet available through their state program, and 47% stated that they did not want to use different vaccines for their public and private patients. Only 11% believed that Pediarix was not compatible with their other vaccine products. Physicians that currently were purchasing or considering purchasing Pediarix were more likely to be influenced by both parental and provider desire to decrease the number of injections at a single visit and the reduced time for immunization delivery. Fewer than 1% of respondents reported either having experienced or expecting to experience a significant decrease in practice revenue as a result of the use of Pediarix.

CONCLUSIONS. Although use of the vaccine results in fewer administration fees for most physicians, the magnitude of the change seemed not to be significant for the majority of respondents or was outweighed by other factors. It also is possible that larger practices or buying cooperatives were able to negotiate discounted rates for Pediarix relative to the constituent products. This may have been a strategy of manufacturers and/or distributors to provide incentive for practices to switch to the combination product. Of note was the appreciation of respondents for the preferences of patients for fewer vaccines and, to a lesser degree, for the decrease in office staff time required to provide vaccination with multiple antigens when using Pediarix. Also, the role of the availability of a given vaccine through the Vaccines for Children program is important in its adoption into practice.

---

Key Words: vaccine • Pediarix • combined • immunization utilization

Abbreviations: VFC—Vaccines for Children

---

Accepted Feb 17, 2006.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				C. A. Gidengil, D. Rusinak, N. J. Allred, D. Luff, G. M. Lee, and T. A. Lieu Financial Barriers to Implementing Combination Vaccines: Perspectives From Pediatricians and Policy Makers Clinical Pediatrics, June 1, 2009; 48(5): 539 - 547. [Abstract] [PDF]

				S. H. Jacobson and E. C. Sewell A Web-based Tool for Designing Vaccine Formularies for Childhood Immunization in the United States J. Am. Med. Inform. Assoc., September 1, 2008; 15(5): 611 - 619. [Abstract] [Full Text] [PDF]