TY - JOUR
T1 - Modeling the economic impact of different vial-opening thresholds for measles-containing vaccines
AU - Wedlock, Patrick T.
AU - Mitgang, Elizabeth A.
AU - Oron, Assaf P.
AU - Hagedorn, Brittany L.
AU - Leonard, Jim
AU - Brown, Shawn T.
AU - Bakal, Jennifer
AU - Siegmund, Sheryl S.
AU - Lee, Bruce Y.
N1 - Funding Information:
This work was supported by the Bill and Melinda Gates Foundation, the Agency for Healthcare Research and Quality (AHRQ) via grant R01HS023317, National Institute of General Medical Sciences Modeling Infectious Disease Agent Study (MIDAS) Informatics Services Group grant 1U24GM110707, and the Global Obesity Prevention Center (GOPC) at Johns Hopkins and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the Office of the Director, National Institutes of Health (OD) under award number U54HD070725. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
Funding Information:
This work was supported by the Bill and Melinda Gates Foundation , the Agency for Healthcare Research and Quality (AHRQ) via grant R01HS023317 , National Institute of General Medical Sciences Modeling Infectious Disease Agent Study (MIDAS) Informatics Services Group grant 1U24GM110707 , and the Global Obesity Prevention Center (GOPC) at Johns Hopkins and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the Office of the Director, National Institutes of Health (OD) under award number U54HD070725 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
Publisher Copyright:
© 2019 The Authors
PY - 2019/4/17
Y1 - 2019/4/17
N2 - 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.
AB - 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.
KW - Measles vaccine
KW - Policy
KW - Presentation
KW - Vaccine supply chain
UR - https://www.scopus.com/pages/publications/85063278251
UR - https://www.scopus.com/pages/publications/85063278251#tab=citedBy
U2 - 10.1016/j.vaccine.2019.03.017
DO - 10.1016/j.vaccine.2019.03.017
M3 - Article
C2 - 30914223
AN - SCOPUS:85063278251
SN - 0264-410X
VL - 37
SP - 2356
EP - 2368
JO - Vaccine
JF - Vaccine
IS - 17
ER -