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 Siegmund, Bruce Lee

Research output: Contribution to journalArticle

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

Fingerprint

Measles Vaccine
economic impact
Economics
vaccines
Costs and Cost Analysis
dosage
Mozambique
Benin
Niger
Vaccines
supply chain
Economic Models
Health Policy
Immunization
health care workers
Delivery of Health Care
simulation models
immunization
Infection
economics

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

Cite this

Wedlock, P. T., Mitgang, E. A., Oron, A. P., Hagedorn, B. L., Leonard, J., Brown, S. T., ... Lee, B. (2019). Modeling the economic impact of different vial-opening thresholds for measles-containing vaccines. Vaccine, 37(17), 2356-2368. https://doi.org/10.1016/j.vaccine.2019.03.017

Modeling the economic impact of different vial-opening thresholds for measles-containing vaccines. / Wedlock, Patrick T; Mitgang, Elizabeth A.; Oron, Assaf P.; Hagedorn, Brittany L.; Leonard, Jim; Brown, Shawn T.; Bakal, Jennifer; Siegmund, Sheryl; Lee, Bruce.

In: Vaccine, Vol. 37, No. 17, 17.04.2019, p. 2356-2368.

Research output: Contribution to journalArticle

Wedlock, PT, Mitgang, EA, Oron, AP, Hagedorn, BL, Leonard, J, Brown, ST, Bakal, J, Siegmund, S & Lee, B 2019, 'Modeling the economic impact of different vial-opening thresholds for measles-containing vaccines', Vaccine, vol. 37, no. 17, pp. 2356-2368. https://doi.org/10.1016/j.vaccine.2019.03.017
Wedlock PT, Mitgang EA, Oron AP, Hagedorn BL, Leonard J, Brown ST et al. Modeling the economic impact of different vial-opening thresholds for measles-containing vaccines. Vaccine. 2019 Apr 17;37(17):2356-2368. https://doi.org/10.1016/j.vaccine.2019.03.017
Wedlock, Patrick T ; Mitgang, Elizabeth A. ; Oron, Assaf P. ; Hagedorn, Brittany L. ; Leonard, Jim ; Brown, Shawn T. ; Bakal, Jennifer ; Siegmund, Sheryl ; Lee, Bruce. / Modeling the economic impact of different vial-opening thresholds for measles-containing vaccines. In: Vaccine. 2019 ; Vol. 37, No. 17. pp. 2356-2368.
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