Format

Send to

Choose Destination
Vaccine. 2019 Apr 17;37(17):2356-2368. doi: 10.1016/j.vaccine.2019.03.017. Epub 2019 Mar 23.

Modeling the economic impact of different vial-opening thresholds for measles-containing vaccines.

Author information

1
HERMES Logistics Modeling Team, Baltimore, MD & Pittsburgh, PA, United States; Global Obesity Prevention Center (GOPC) at Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
2
Institute for Disease Modeling, Bellevue, WA, United States.
3
HERMES Logistics Modeling Team, Baltimore, MD & Pittsburgh, PA, United States; Pittsburgh Supercomputing Center, Carnegie Mellon University, Pittsburgh, PA, United States.
4
HERMES Logistics Modeling Team, Baltimore, MD & Pittsburgh, PA, United States; McGill Centre for Integrative Neuroscience, McGill Neurological Institute, McGill University, Montreal, Canada.
5
HERMES Logistics Modeling Team, Baltimore, MD & Pittsburgh, PA, United States; Global Obesity Prevention Center (GOPC) at Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States. Electronic address: brucelee@jhu.edu.

Abstract

INTRODUCTION:

The lack of specific policies on how many children must be present at a vaccinating location before a healthcare worker can open a measles-containing vaccine (MCV) - i.e. the vial-opening threshold - has led to inconsistent practices, which can have wide-ranging systems effects.

METHODS:

Using HERMES-generated simulation models of the routine immunization supply chains of Benin, Mozambique and Niger, we evaluated the impact of different vial-opening thresholds (none, 30% of doses must be used, 60%) and MCV presentations (10-dose, 5-dose) on each supply chain. We linked these outputs to a clinical- and economic-outcomes model which translated the change in vaccine availability to associated infections, medical costs, and DALYs. We calculated the economic impact of each policy from the health system perspective.

RESULTS:

The vial-opening threshold that maximizes vaccine availability while minimizing costs varies between individual countries. In Benin (median session size = 5), implementing a 30% vial-opening threshold and tailoring distribution of 10-dose and 5-dose MCVs to clinics based on session size is the most cost-effective policy, preventing 671 DALYs ($471/DALY averted) compared to baseline (no threshold, 10-dose MCVs). In Niger (median MCV session size = 9), setting a 60% vial-opening threshold and tailoring MCV presentations is the most cost-effective policy, preventing 2897 DALYs ($16.05/ DALY averted). In Mozambique (median session size = 3), setting a 30% vial-opening threshold using 10-dose MCVs is the only beneficial policy compared to baseline, preventing 3081 DALYs ($85.98/DALY averted). Across all three countries, however, a 30% vial-opening threshold using 10-dose MCVs everywhere is the only MCV threshold that consistently benefits each system compared to baseline.

CONCLUSION:

While the ideal vial-opening threshold policy for MCV varies by supply chain, implementing a 30% vial-opening threshold for 10-dose MCVs benefits each system by improving overall vaccine availability and reducing associated medical costs and DALYs compared to no threshold.

KEYWORDS:

Measles vaccine; Policy; Presentation; Vaccine supply chain

PMID:
30914223
DOI:
10.1016/j.vaccine.2019.03.017
Free full text

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center