Measuring immunization registry costs - Promises and pitfalls

Introduction: The medical and public health communities advocate die use of immunization registries as one tool to achieve national goals for immuniza tion. Despite the considerable investment of resources into registry develo pment, little information is available about the costs of developing or mai ntaining a registry. Methods: The objective of this study was to measure the direct costs of mai ntaining one immunization registry. Cost and resource-use data were collect ed by interviewing registry personnel and staff at participating pediatric practices, collecting available financial records, and direct observation. Results: The estimated direct cost for maintaining the registry during the 3 calendar years 1995 through 1997 tvas $439,232. In 1997, this represented an annual cost of $5.26 per child immunized whose record was entered into the registry. In all years, personnel expenses represented at least three f ourths of the total costs, with the majority of administrative effort donat ed. Yearly costs increased over time largely because of growing; administra tive personnel requirements as the registry became fully operational. Conclusion: Considerable resources are required to establish and maintain i mmunization registries. Because personnel costs, particularly nontechnical personnel, represent a large portion of total registry costs, it is importa nt to accurately account for donated effort, Recommendations for future reg istry cost studies include prospective data collection and focusing upon th e costs of providing specific outreach or surveillance functions rather tha n overall registry costs. In addition, registry effectiveness evaluations a re needed to translate registry costs into cost-effectiveness ratios.