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

Patrick T. Wedlock, Elizabeth A. Mitgang, Assaf P. Oron, Brittany L. Hagedorn, Jim Leonard, Shawn T. Brown, Jennifer Bakal, Sheryl S. Siegmund, Bruce Y. Lee

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)2356-2368
Number of pages13
JournalVaccine
Volume37
Issue number17
DOIs
StatePublished - Apr 17 2019

Keywords

  • Measles vaccine
  • Policy
  • Presentation
  • Vaccine supply chain

ASJC Scopus subject areas

  • Molecular Medicine
  • Immunology and Microbiology(all)
  • veterinary(all)
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

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