Effectiveness and net cost of reminder/recall for adolescent immunizations

Pediatrics. 2012 Jun;129(6):e1437-45. doi: 10.1542/peds.2011-1714. Epub 2012 May 7.


Objective: To assess the effectiveness of reminder/recall (R/R) for immunizing adolescents in private pediatric practices and to describe the associated costs and revenues.

Methods: We conducted a randomized controlled trial in 4 private pediatric practices in metropolitan Denver. In each practice, 400 adolescents aged 11 to 18 years who had not received 1 or more targeted vaccinations (tetanus-diphtheria-acellular pertussis, meningococcal conjugate, or first dose of human papillomavirus vaccine for female patients) were randomly selected and randomized to intervention (2 letters and 2 telephone calls) or control (usual care) groups. Primary outcomes were receipt of >1 targeted vaccines and receipt of all targeted vaccines 6 months postintervention. We calculated net additional revenue for each additional adolescent who received at least 1 targeted vaccine and for those who received all targeted vaccines.

Results: Eight hundred adolescents were randomized to the intervention and 800 to the control group. Baseline rates of having already received tetanus-diphtheria-acellular pertussis, meningococcal conjugate, and first dose of human papillomavirus vaccine before R/R ranged from 33% to 54%. Postintervention, the intervention group had significantly higher proportions of receipt of at least 1 targeted vaccine (47.1% vs 34.6%, P < .0001) and receipt of all targeted vaccines (36.2% vs 25.2%, P < .0001) compared with the control group. Three practices had positive net revenues from R/R; 1 showed net losses.

Conclusions: R/R was successful at increasing immunization rates in adolescents and effect sizes were comparable to those in younger children. Practices conducting R/R may benefit financially if they can generate additional well-child care visits and keep supply costs low.

Trial registration: ClinicalTrials.gov NCT00715234.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Child
  • Cost-Benefit Analysis
  • Diphtheria-Tetanus-acellular Pertussis Vaccines / economics
  • Diphtheria-Tetanus-acellular Pertussis Vaccines / therapeutic use
  • Female
  • Humans
  • Immunization / economics*
  • Immunization / trends
  • Immunization Schedule*
  • Male
  • Meningococcal Vaccines / economics
  • Meningococcal Vaccines / therapeutic use
  • Papillomavirus Vaccines / economics
  • Papillomavirus Vaccines / therapeutic use
  • Patient Participation / economics*
  • Patient Participation / trends
  • Reminder Systems / economics*
  • Reminder Systems / trends
  • Treatment Outcome


  • Diphtheria-Tetanus-acellular Pertussis Vaccines
  • Meningococcal Vaccines
  • Papillomavirus Vaccines

Associated data

  • ClinicalTrials.gov/NCT00715234