Analysis of Cost Versus Care-Should a pediatrician use a less expensive

Analysis of Cost Versus Care

Discussion Question:

Should a pediatrician use a less expensive and well-established vaccination product with adequate reimbursement rather than a newer, more expensive version with better bacterial protection that has a lower profit margin? You should analyze the ethical issues, from the provider, patient, and healthcare manager perspective.

Case Presentation

In 2001, Wyeth Vaccines (presently known as Pfizer) marketed a vaccine product known as Prevnar 7 (PCV7). The product enjoyed the full backing of the Center for Disease Control and Prevention (CDC), and several professional organizations recommended and endorsed its usage in the pediatric population. The product was used successfully for over a decade. As predicted, there was a definitive drop in the frequency of otitis media and, in addition, there was a diminished number of cases of blood stream infection and meningitis caused by the 7 (hence the name) subgroups of this particular bacterium.

In 2010, the vaccine producer was granted approval to market a new version – Prevnar 13 (PCV13) – that added substantial improvement in the vaccine protection rates, especially now that there would be protection for 13 subgroups instead of the initial 7 groups. As might be expected, the vaccination also came with a higher cost than PCV 7, and there was substantial hesitance, initially, on the part of local insurers to cover the vaccination – as PCV7 was still usable and well-established. Eventually, as it became apparent that the insurance carriers made PCV13 a “covered service” – meaning that the vaccine was allowed on the insurance company’s immunization formulary – the reimbursement margin to physicians providing the new vaccination would be substantially less that the margin for PCV7.

Members of the local pediatric community engaged in a heated discussion regarding this issue. Some felt that the parents of the child should make the decision as to which vaccination they preferred and pay the difference (out of pocket) for the difference in the vaccine cost. Others advocated a boycott of the new product, noting that the PCV7 was adequate and that the protection was sufficient. One of the pediatricians, a local expert in infectious diseases, stated very clearly that national medical organizations such as the Advisory Committee for Immune Practices (ACIP) and the American Academy of Pediatrics (AAP) had issued statements supporting the use of the newer product. The local medical ethicist – also a pediatrician – argued that children should not be “held as a hostage” in the deliberation with insurance companies and that the pediatrician had a prima facie duty to offer the best available care to the child.

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