Immunization Information System Opt-In Consent: At What Cost?

Context: Immunization information systems (IISs) are confidential, population-based computerized systems that contain immunization data for children, and in some cases adults, within a geographic area. There are generally two models for participation in an IIS, termed voluntary exclusion or “opt-out” and voluntary inclusion, or “opt-in.” Objective: Using the Texas opt-in consent system and statewide IIS, ImmTrac, we describe the costs associated with obtaining opt-in consent in hospitals as part of the birth registration process and consent collected beyond the newborn period in medical provider offices. We also propose the costs associated with a theoretical opt-out system. Methods: Between October, 2006 and August, 2007, trained project staff conducted on-site time studies in 8 birthing hospitals (n=281), 16 medical provider offices (n=131) serving both the public and private health sectors, and in ImmTrac state offices in Austin, Texas (n=100). Cost is estimated using a time-motion study where only the time associated with obtaining consent was measured. The cost of processing and storing consent at ImmTrac offices was included. Results: The average per child cost associated with consent completed at birth is $1.84, while the per child cost for consent completed beyond the newborn period is $2.81. The annual costs of operating an alternative, opt-out system are estimated at $0.20 per child.

Conclusion: The proposed opt-out costs were demonstrated to be substantially less than the actual opt-in model currently utilized. Changing to an opt-out system could redirect limited health care funding to more critical areas such as vaccine purchasing and administration.