Persuading more U.S. adults to get their shots could save the country as much as $9 billion a year and eliminate as many as 18 million cases of misery a year.

Sachiko Ozawa, a researcher at the University of North Carolina, and a group of colleagues have put data supporting that conclusion in a paper published behind a paywall by Health Affairs, an academic journal that focuses on health care finance and health care delivery systems.

Related: Fewer fevers, aches in mild flu season help health insurers

The researchers analyzed the economic burden imposed on adults by infectious diseases that can be prevented with readily available vaccinations.

The list includes 14 conditions, including rare conditions such as tetanus and common conditions such as the flu.

The Affordable Care Act now requires commercial health plans to cover vaccines for those conditions without imposing out-of-pocket costs on the patients.

The researchers found that the flu, a common condition, affects a total of about 17 million U.S. adults per year and causes about $5.9 billion in medical costs and productivity losses.

For adults age 19 to 49, human papillomavirus is the second most costly condition, causing $256 million in burden for about 365,000 people.

For adults age 65 and older, flu ranks first, and pneumonia ranks second. Pneumonia causes $1.7 billion in potentially vaccine-preventable burden for 235,000 older adults.

For people age 50 to 64, flu ranks first, causing 3.9 million infections and $1.4 billion in burden. Shingles leads to about 513,000 infections in middle-age Americans and $406 million in burden.

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