(sometimes including the cost of registry development and maintenance). Other costs, such as outreach, education, training, data collection, and surveillance of coverage rates and vaccine safety, are incurred by public health agencies (as discussed later in this chapter). The American Academy of Pediatrics has estimated that its members charge approximately $15 per dose for vaccine administration (Fleming, 1995). Vaccine administration fees for adults are significantly lower, and range from $3.95 to $5.38 within the Medicare program, depending on the provider’s location (Health Care Financing Administration, 1999a). Such expenses are difficult to monitor, however, because they may or may not be billed separately within well-child visits or other office procedures, depending on

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