Assessing the impact of wastage on pediatric vaccine immunization formulary costs using a vaccine selection algorithm

Jacobson, Sheldon H.; Karnani, Tamana; Sewell, Edward C.

doi:10.1016/j.vaccine.2003.11.018

Cited by 11 publications

(9 citation statements)

References 10 publications

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“…The wasted doses of a vaccine have a direct relation with its costs, since they translate into a higher effective price of vaccine acquisition according to expression (2) [3]:…”

Section: Wastage Of Diphtheria Tetanus Pertussis and Haemophilus Inmentioning

confidence: 99%

“…Although present in every country, this wastage is especially important for poor countries, which do not always have the means to develop an adequate supply-chain of vaccine distribution [2]. Therefore, the cost impact of this wastage needs to be evaluated, an analysis which is, however, seldom made [3]. As an example, the wastage of the DPT-w vaccine in the United States was estimated as 1.7%, with an average loss of vaccines of 5.3% [4].…”

Section: Introductionmentioning

confidence: 99%

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Wastage of Diphtheria, Tetanus, Pertussis and Haemophilus influenzae type-b vaccine (Tetravalent vaccine) and its impact on the increase of dose costs

Novaes

Almeida

Bastos

et al. 2011

2011 Pan American Health Care Exchanges

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Objective: Identify the monthly wastage of the Tetravalent vaccine (Diphtheria, Tetanus, Pertussis and Haemophilus influenzae type b vaccine) and to quantify the monetary importance of such wastage for the public sector of Brazil. Methodology: The monthly vaccine wastage of the vaccination centers coordinated by the Epidemiology monitoring service of the Department of Health, Juiz de Fora city, MG, was analyzed in the period September 2008 -May 2010. Its impact on the cost of the Tetravalent vaccine was also estimated. Results: The number of doses of Tetravalent vaccine distributed was 45340, with a monthly average of 2160 distributed doses, in the considered period. The monthly average wastage was minimum in November 2008 (10%), and maximum in April 2009 (43%). The average wastage was 16%, or 7255 doses. Conclusion: vaccine wastages are significant in the country.

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“…The wasted doses of a vaccine have a direct relation with its costs, since they translate into a higher effective price of vaccine acquisition according to expression (2) [3]:…”

Section: Wastage Of Diphtheria Tetanus Pertussis and Haemophilus Inmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Wastage of Diphtheria, Tetanus, Pertussis and Haemophilus influenzae type-b vaccine (Tetravalent vaccine) and its impact on the increase of dose costs

Novaes

Almeida

Bastos

et al. 2011

2011 Pan American Health Care Exchanges

View full text Add to dashboard Cite

show abstract

“…There are several articles in the literature that report research that applies operations research techniques to pediatric immunization problems (e.g., [20][21][22][24][25][26]). This paper moves in a new direction by applying discrete optimization techniques to address the issue of pediatric vaccine extraimmunization.…”

Section: Conclusion and Research Extensionsmentioning

confidence: 99%

“…This combinatorial explosion of vaccine alternatives and choices has motivated the use of operations research techniques in addressing pediatric immunization formulary design problems. Most of the research to date addresses the economics of pediatric vaccine formulary design, combination vaccine pricing, and vaccine wastage [21,23]. Weniger et al [32] report the results of a pilot study that uses operations research methods to assess the economic value of vaccine formularies (i.e., the set of vaccines inventoried by an immunization clinic or pediatrician).…”

Section: Introductionmentioning

confidence: 99%

Maximizing the effectiveness of a pediatric vaccine formulary while prohibiting extraimmunization

Hall

Sewell

Jacobson

2008

Health Care Manage Sci

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The growing-complexity of the United States Recommended Childhood Immunization Schedule has resulted in as many as five required injections during a single well-baby office visit. To reduce this number, vaccine manufacturers have developed combination vaccines that immunize against several diseases in a single injection. At the same time, a growing number of parents are challenging the safety and effectiveness of vaccinating children. They are also particularly concerned about the use of combination vaccines, since they believe that injecting a child with multiple antigens simultaneously may overwhelm a child's immune system. Moreover, combination vaccines make it more likely that extraimmunization (i.e., administering more than the required amount of vaccine antigens) occurs, resulting in greater concerns by parents and vaccine wastage costs borne by an already strained healthcare system. This paper formulates an integer programming model that solves for the maximum number of vaccines that can be administered without any extraimmunization. An exact dynamic programming algorithm and a randomized heuristic for the integer programming model is formulated and the heuristic is shown to be a randomized xi-approximation algorithm. Computational results are reported on three sets of test problems, based on existing and future childhood immunization schedules, to demonstrate their computational effectiveness and limitations. Given that future childhood immunization schedules may need to be solved for each child, on a case-by-case basis, the results reported here may provide a practical and valuable tool for the public health community.

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“…These efforts have spanned a broad spectrum of problems, ranging from vaccine procurement and distribution [10], the economic analysis of pediatric vaccine formularies, including the impact of combination vaccines [11,12,21], and vaccine configuration and the design of DNA vaccines [5,9,22]. This paper analyzes the pediatric vaccine stockpile levels proposed by the United States Department of Health and Human Services to determine the risks associated with such levels in the event of vaccine production interruptions.…”

Section: Introductionmentioning

confidence: 99%

An analysis of the pediatric vaccine supply shortage problem

Jacobson

Sewell

2006

Health Care Manage Sci

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In 2002, several factors resulted in pediatric vaccine manufacturers not being able to produce a sufficient number of vaccines to vaccinate all the children in the United States according to the Recommended Childhood Immunization Schedule. The resulting vaccine supply shortage resulted in thousands of children not being fully immunized according to this schedule, and hence, created an unnecessary risk for epidemic outbreaks of several childhood diseases. The Centers for Disease Control and Prevention responded to this crisis by using pediatric vaccine stockpiles to mitigate the impact of future shortages. This paper presents a stochastic model that captures the vaccine supply during production interruptions. This model is used to assess the impact of pediatric vaccine stockpile levels on vaccination coverage rates, by considering the probability that all children can be immunized according to the Recommended Childhood Immunization Schedule over a given time period and the expected minimum vaccine supply. The model is also used to assess the proposed pediatric vaccine stockpile levels recommended by the United States Department of Health and Human Services. The results of this analysis suggest that the proposed vaccine stockpile levels are adequate to meet future vaccine production interruptions, provided that such production interruptions do not last more than six months (which is not surprising, given that is the time period for which they were designed). However, given that recent vaccine production interruptions have lasted (on average) for over one year, the proposed vaccine stockpile levels are insufficient to meet the nation's pediatric immunization needs during such time periods, which in turn could lead to localized and/or widespread disease outbreaks. Moreover, a moderate investment in higher vaccine stockpile levels would lead to a significantly reduced risk of such events.

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Assessing the impact of wastage on pediatric vaccine immunization formulary costs using a vaccine selection algorithm

Cited by 11 publications

References 10 publications

Wastage of Diphtheria, Tetanus, Pertussis and Haemophilus influenzae type-b vaccine (Tetravalent vaccine) and its impact on the increase of dose costs

Wastage of Diphtheria, Tetanus, Pertussis and Haemophilus influenzae type-b vaccine (Tetravalent vaccine) and its impact on the increase of dose costs

Maximizing the effectiveness of a pediatric vaccine formulary while prohibiting extraimmunization

An analysis of the pediatric vaccine supply shortage problem

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