The Cost of Doing Business: Cost Structure of Electronic Immunization Registries


  • John M Fontanesi,

  • Don S Flesher Jr.,

  • Michelle De Guire,

  • Allan Lieberthal,

  • Kathy Holcomb

  • This research was supported by CDC Award no. U1W/CCU914714-01. Contents are solely the responsibility of the authors and do not necessarily represent the official view of the Centers for Disease Control and Prevention.

Address correspondence to John M. Fontanesi, Ph.D., Partnership of Immunization Providers, School of Medicine, Department of Pediatrics, University of California, San Diego, 9500 Gilman Drive, MC 0927, La Jolla, CA 92093-0927. Dr. Fontanesi, Principal Investigator, is an Associate Professor. Michelle De Guire, M.P.H., M.S.W., is a Program Manager, and Kathy Holcomb, M.A., is an Editor with the same institution. Don S. Flesher Jr., Technical Consultant, is President, International Health Systems, Inc., Los Angeles, CA. Allan Lieberthal, M.D., Co-Investigator, is with Kaiser-Permanente, Panorama City, CA.


Objective. To predict the true cost of developing and maintaining an electronic immunization registry, and to set the framework for developing future cost-effective and cost-benefit analysis.

Data Sources/Study Setting. Primary data collected at three immunization registries located in California, accounting for 90 percent of all immunization records in registries in the state during the study period.

Study Design. A parametric cost analysis compared registry development and maintenance expenditures to registry performance requirements.

Data Collection/Extraction Methods. Data were collected at each registry through interviews, reviews of expenditure records, technical accomplishments development schedules, and immunization coverage rates.

Principal Findings. The cost of building immunization registries is predictable and independent of the hardware/software combination employed. The effort requires four man-years of technical effort or approximately $250,000 in 1998 dollars. Costs for maintaining a registry were approximately $5,100 per end user per three-year period.

Conclusions. There is a predictable cost structure for both developing and maintaining immunization registries. The cost structure can be used as a framework for examining the cost-effectiveness and cost-benefits of registries. The greatest factor effecting improvement in coverage rates was ongoing, user-based administrative investment.