Designing pediatric vaccine formularies and pricing pediatric combination vaccines using operations research models and algorithms

Jacobson, Sheldon H.; Sewell, Edward C.; Allwine, Daniel A.; Medina, Enrique A.; Weniger, Bruce G.

doi:10.1586/14760584.2.1.15

Cited by 17 publications

(8 citation statements)

References 3 publications

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“…However, such actions may lead to competing manufacturers exiting the pediatric vaccine market, resulting in a vaccine monopoly that in turn could lead to large price increases in the long term. Given that the federal government purchases 60% of pediatric vaccines in the United States, they are well positioned to prevent such a future situation or crisis [14].…”

Section: Discussionmentioning

confidence: 99%

“…The vaccine selection algorithm can also be used to compare the DTPa-HBV-IPV and DTPa-HIB-IPV vaccines by reverse engineering their prices, both individually and head-to-head. Such information can be of value to both vaccine manufacturers (in anticipating the potential market value for each combination vaccine) and health care providers (in determining which vaccine is of better value for their particular immunization environment, since these two combination vaccines are not designed to be used simultaneously; see [14]) to assess a vaccine's market value. This paper describes how the vaccine selection algorithm can be used to evaluate and compare two partially overlapping combination vaccines (DTPa-HBV-IPV and DTPa-HIB-IPV) for pediatric immunization.…”

Section: Introductionmentioning

confidence: 99%

“…HBV-HIB in months 2 and 4, and DTPa-HIB in months[12][13][14][15][16][17][18]. When all combination vaccines (including the DTPa-HBV-IPV vaccine) are available to be included in the vaccine formulary, 16 or 17 injections can be administered (resulting in a reduction of 2 or 3 injections from the previous case, or 6 injections from the base case).…”

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confidence: 99%

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Engineering the Economic Value of Two Pediatric Combination Vaccines

Jacobson

Sewell

Karnani³

2005

Health Care Manage Sci

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Combination vaccines for pediatric immunization have become an effective means to reduce the number of separate injections required to immunize children according to the United States Recommended National Childhood Immunization Schedule. This paper reports the results of using operations research methodologies to analyze the price and value of two pentavalent combination vaccines for pediatric immunization: diphtheria-tetanus-acellular pertussis, hepatitis B, inactivated polio (DTPa-HBV-IPV) and diphtheria-tetanus-acellular pertussis, Haemophilus influenzae type B, inactivated polio (DTPa-HIB-IPV). These two combination vaccines are analyzed both individually and head-to-head, as a function of the cost of administering (or avoiding) an injection and the number of doses of the vaccine required to be in the lowest overall cost vaccine formulary. The main contribution of the paper is to provide a methodology for analyzing the impact of combination vaccines on pediatric vaccine formularies. This analysis shows that the DTPa-HBV-IPV vaccine may provide a good value at the current federally negotiated price of 32.75 dollars for a wide spectrum of health-care environments, though the actual number of injections that it reduces may be fewer than the optimistic numbers claimed by its manufacturer. The analysis also shows that if the DTPa-HIB-IPV vaccine is approved by the Food and Drug Administration (FDA), then under current market prices, it may need to be priced below the sum of its vaccine component prices to favorably compete with the DTPa-HBV-IPV vaccine.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Engineering the Economic Value of Two Pediatric Combination Vaccines

Jacobson

Sewell

Karnani³

2005

Health Care Manage Sci

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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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“…3 To cut down on vaccination appointments but maintain vaccine take-up, combined vaccines are utilized or co-administration is practiced, with different vaccines given in different parts of the body in one visit. 4 Simultaneous administration is universally recognized as improving vaccination coverage in children as it does not interfere with development of the immune response to the injected antigens, does not significantly increase reactogenicity and does not compromise vaccination safety, [5][6][7] though the effect of simultaneous administration on immune responses is still under debate. In fact some studies have shown that vaccine combination did not decrease immunogenity of single vaccine antigens, but that it could increase the immune response.…”

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confidence: 99%