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Background Vaccines have been used successfully for disease elimination programs in many countries. Evidence on the impact of vaccination programs can support decision-making among medical practitioners and policy makers to improve immunization rates. We estimated the health and economic impact of measles vaccination for each of the 48 contiguous states and the District of Columbia since 1964. Methods For each state, we fitted multiple time-series models to prevaccination data and used the best-fitting model to predict counterfactual cases that would have occurred in the absence of vaccination. We then subtracted observed from counterfactual measles cases, deaths, and related costs to estimate the impact of vaccination. Results We estimated that 149 million children were vaccinated against measles in the United States between 1964 and 2014, at a cost of $12.2 billion, and that vaccination prevented 29.8 million cases, 32 000 deaths, and $25.8 billion in societal costs. The impact exceeded the national average in 70% of Western and Northeastern states, compared with only 24% of Southern and Midwestern states. Conclusions The significant health and economic benefit of measles vaccination in the United States should encourage continued investments to sustain and expand vaccination programs globally.

Heterogeneity Between States in the Health and Economic Impact of Measles Immunization in the United States