The Ultimate Guide to Flu-Shot Shopping

Table: Flu Shot Prices

One thing about flu worries: They’re catching.

Already there is concern about the need for two shots this year — seasonal flu and H1N1, also known as swine flu. But with children in a handful of states already getting their nasal spray vaccines for H1N1, consumers are sorting through a bewildering maze of flu choices. Do I need both shots? What kind of immunization is best, shot or nasal spray? With retailers advertising they’ll do it for cheap, where do I go to get inoculated?

Weeks before the flu season’s official start of Oct. 4, the Centers for Disease Control and Prevention reported an elevated number of cases. From Sept. 20-26, the CDC reported 2,126 new cases of influenza nationwide -- all but 1% of them H1N1. News reports, letters home from school, and public safety campaigns, have both raised consumer awareness and triggered concerns about safety. Earlier this month, New York health-care workers protested mandatory H1N1 vaccinations, saying they shouldn’t be forced to receive a potentially dangerous vaccine to keep their jobs.

Another potential for concern: availability. Of the 2.4 million doses of H1N1 nasal spray vaccine shipped last week, health-care providers have already snapped up 2.2 million. The Connecticut attorney general is also seeking answers from manufacturer Novartis (NVS) regarding potential shortages of seasonal flu vaccine.

In fact, the confusion that consumers face this flu season underscores just how out of whack the U.S. health-care system can be, even as the nation debates reform. Doctors, for example, say flu vaccines do not contribute substantially to their income — and that they provide the doses as a public service. A 2008 University of Michigan survey found that nationwide, 11% of physicians said they were considering eliminating all immunization offerings for privately insured children because of the losses.

Dr. Anatoly Belilovsky, a pediatrician based in Staten Island, N.Y., says he pays Sanofi Aventis (SNY) about $140 for a 10-dose vial of Fluzone. He charges each patient being vaccinated the cost of a single dose ($14) and a $17 administration fee to cover office costs and his time (Belilovsky administers the shots himself), for a total of $31. Insurance reimburses him $20 to $30, including any copay. “You generally break even with private insurance,” he says.

Likewise, flu vaccines represent small profits for the large pharmaceutical companies that make them. GlaxoSmithKline's (GSK) Fluarix and FluLaval vaccines, for example, brought in roughly $135 million during 2008, or 0.91% of the company’s $14.7 billion U.S. pharmaceutical sales, according to the firm’s annual report. In comparison, its hepatitis vaccine took in $438 million, or 3% of U.S. sales.

However, both doctors and manufacturers could stand to profit. Down the road, manufacturers could cash in by expanding their sales to developing nations, says Hedwig Kresse, a senior analyst of infectious diseases for market researcher Datamonitor. China’s ongoing health-care reform, which aims to offer coverage to more than 90% of the population by 2011, is expected to be very lucrative for vaccine manufacturers, according to a July 2009 report from IMS Health. And in its 2008 annual report, Glaxo identified emerging market vaccine sales as one of its highest growth areas.

For doctors, there could be a benefit with patients who pay cash. According to the CDC, a 10-pack of FluMist Sprayers averages $19.70 per dose to physicians and retailers. Vaccines administered via injection average $9.72 to $13.25 apiece. Although doctors have to absorb the loss of providing the vaccine free to Medicare clients, they can also charge a premium to their uninsured patients.

The bottom line: Before you make any decision about your vaccines, be informed. Here are answers to some key questions about getting a flu shot. Be sure to click through to the end to see our chart on the prices and promotions big-name retailers are offering on seasonal flu immunizations.

How important is it that I get the seasonal flu vaccination?
Do your math. In an average year, 5% to 20% of consumers come down with seasonal influenza. If you get the vaccine, you reduce your risk of falling ill by 70% to 95%, says Dr. Litjen Tan, the director of medicine and public health for the American Medical Association. Most doctors recommend getting the shot if you’re in the high-risk group. For seasonal flu, that includes anyone 24 or younger, pregnant women and people with weakened immune systems, as well as those who have direct contact with an at-risk group.

Which at-risk groups might need the swine flu vaccine?
For H1N1, doctors advise the shot for people age 18 or younger, age 65 or older, pregnant women, people with weakened immune systems, and anyone who has direct contact with at-riskers.