Title

Can a compact prefilled auto-disable injection system (cPAD) save costs for DTP-HepB-Hib vaccine as compared to single-dose (SDV) and multi-dose vials (MDV)? Evidence from Cambodia, Ghana and Peru.

Journal

Drugs: Real World Outcomes

Authors names

Cyril Nogier, Patrick Hanlon, Karin Wiedenmayer, Nicolas Maire

Affiliation and e-mail address of the corresponding author

Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002 Basel, Switzerland

Table 6:Source of parameter values and their estimation mode

Parameters in the model / Cambodia / Ghana / Peru
Time horizon / NIP strategic plan 2013-2020 / EPI planning horizonoffive years / Strategic plan of theEstratégia nacional de inmunizaciones (ESNI)
Population at start year / Statistics Bureau, Ministry of Internal Affairs and communications, japan
/ Immunization Program Comprehensive Multi-Year Plan 2010-2014 revised May 2011 / Estado de la población peruana 2012.Instituto Nacional de Estadísticas Informática. Julio 2012
Birth rate 2011 (natality) / United Nations. World Population Prospects. The 2012 Revision. / Immunization Program Comprehensive Multi-Year Plan 2010-2014 revised May 2011 /
Growth rate of population for 2013-2017 / United Nations. World Population Prospects. The 2012 Revision. / Immunization Program Comprehensive Multi-Year Plan 2010-2014 revised May 2011 /
Immunization coverage of the pentavalent / Ministry of health, 2012 / Ghana Health Service 2011 Annual Report / WHO statistics, 2012

Number of pentavalent injections in children 0 -1 year old / Cambodia Immunization schedule, 2013 NIP / Ghana Health Service, Immunization Program Comprehensive Multi-Year Plan (2010-2014) / Peruvian Ministry of health immunization schedule
Price of pentavalent in SDV- FCA / The vaccine prices used in the model are expected prices in 2016 comparable to major procurement prices. Personal communication with the pentavalent vaccine manufacturer in SDV. / UNICEF_2013_DTP-HepB-Hib.pdf lowest price for 2016from Serum Institute of India Ltd. / The vaccine prices used in the model are expected prices in 2016 comparable to major procurement prices. Personal communication with the pentavalent vaccine manufacturer in SDV.
Price of pentavalent in cPAD - FCA / The vaccine prices used in the model are expected prices in 2016 comparable to major procurement prices.Personal communication with the pentavalent vaccine manufacturer (that plans to launch cPAD). / The vaccine prices used in the model are expected prices in 2016 comparable to major procurement prices.Personal communication with the pentavalent vaccine manufacturer (that plans to launch cPAD).. / The prices used in the model are expected prices in 2016 comparable to major procurement prices.Personal communication with the pentavalent vaccine manufacturer (that plans to launch cPAD)..
Taxes on FCA for vaccine procured through UNICEF / Personal communication with NIP, 02.2013 / Procurement Manager, Ghana Health Service (GHS) / InstitutoNacional de Salud, 2012
Price of syringes 0.5 ml (AD, 25 G * 1”) – FCA / /
UNICEF Auto-disable_AD_syringes_and_Safety_Boxes_price_data.pdf (UNICEF 2012) /
UNICEF Auto-disable_AD_syringes_and_Safety_Boxes_price_data.pdf (UNICEF 2012) / InstitutoNacional de Salud, 2012
Price of safety boxes (5 l) - FCA / /
UNICEF Auto-disable_AD_syringes_and_Safety_Boxes_price_data.pdf (UNICEF 2012) / /
UNICEF Auto-disable_AD_syringes_and_Safety_Boxes_price_data.pdf (UNICEF 2012) / /
UNICEF Auto-disable_AD_syringes_and_Safety_Boxes_price_data.pdf (UNICEF 2012)
Taxes on FCA for safe injection procured through UNICEF / Personal communication with NIP, 02.2013 / Procurement Manager, Ghana Health Service. / InstitutoNacional de Salud, 2012
Procurement management costs in % / Personal communication with NIP, 02.2013 / None / Personal communication with ESNI, 12.2012
Volume of the pentavalent in SDV or MDV format / SDV format: personal communication with Crucell on 10.2012 / MDV-10 format per dose:
/ SDV format: personal communication with Crucell on 10.2012
Volume of the pentavalent in cPAD / Personal communication with Crucell on 10.2012 / Personal communication with Crucell on 10.2012 / Personal communication with Crucell on 10.2012
Volume of the syringes / PQS device catalogue, 2012. E008 p. 165
/ PQS device catalogue, 2012 .E008 p. 165
/ Personal communication with Vanish Point, 01.2013
Volume of the safety boxes (5 l) – packed / WHO vaccine volume calculator 2012 / WHO Vaccine Volume Calculator 2012 / WHO vaccine volume calculator 2012
Weight of the safety boxes (5 l) / WHO vaccine volume calculator 2012 / WHO vaccine volume calculator 2012
Put complete reference / WHO vaccine volume calculator 2012
Put complete reference
Wastage rate of pentavalent in SDV / Ministry of Health, 2012 / WHO, 2000 / WHO, 2000
Put complete reference
Wastage rate of pentavalent in cPAD / Sutanto et al., 2009 / Sutanto et al., 2009 / Sutanto et al., 2009
Wastage rate of syringes and safety boxes (5 l) / WHO, 2002. Guidelines for estimating costs of introducing new vaccines into the nation immunization system. / WHO, 2002. Guidelines for estimating costs of introducing new vaccines into the nation immunization system. / WHO, 2002. Guidelines for estimating costs of introducing new vaccines into the nation immunization system.
Number of syringes per safety box (5l) / PATH 2012, Planning for the Introduction of Quinvaxem in Uniject. Healthcare Waste Management Considerations. Draft report. Unpublished / PATH 2012, Planning for the Introduction of Quinvaxem in Uniject. Healthcare Waste Management Considerations. Draft report. Unpublished / Personal communication with VanishPoint corporation, 10.2013
Number of cPAD devices per safety box (5l) / PATH 2012, Planning for the Introduction of Quinvaxem in Uniject. Healthcare Waste Management Considerations. Draft report. Unpublished / PATH 2012, Planning for the Introduction of Quinvaxem in Uniject. Healthcare Waste Management Considerations. Draft report. Unpublished / PATH Draft Dec. 15th, 2012 PATH (2012). Unpublished
Weight of the pentavalent in cPAD (filled / empty) / Personal communication with Crucell on 10.2012 / Personal communication with Crucell on 10.2012 / Personal communication with Crucell on 10.2012
Weight of the pentavalent (filled / empty vial) / Personal communication with Crucell on 10.2012
(SDV) / Lee et al, 2010. (empty vial)
Authors’ estimates (full vial)
(MDV) / Personal communication with Crucell on 10.2012
(SDV)
Weight of syringes
Secondary packaging an syringe alone / Personal communication with Becton Dickinson, 12.2013 / Personal communication with Becton Dickinson, 12.2013 / Personal communication with Vanish point corporation, 10.2013
Volume of the safety box (5l) - unpacked / WHO vaccine volume calculator, 2012 / WHO vaccine volume calculator, 2012 / WHO vaccine volume calculator, 2012
Transportation costs of vaccine from central to provincial level / Authors’ estimate based on Central medical stores (CMS) dataon annual recurrent costs born for the distribution of all EPI vaccines/safe injection material including
by CMS including (fuel and maintenance of vehicles, perdiem of drivers).
The same vehicle transports vaccines and safety injection material together, / Author's estimate as these costs are part of regular GHS budget at each level and are not differentiated.. / Experts’ opinion (UNICEF Peru). Based on estimates of the contract costs of the MoHMoH, Directorate of Supply of strategic health resources (DARES), that contracts local transporters(by air or ground) that ship vaccines to regional level based on the weight of vaccines.
Transportation costs – not refrigerated from central to provincial al level / Authors’ estimate based on Central medical stores (CMS) data on annual recurrent costs born for the distribution of all EPI vaccines/safe injection material including
by CMS including (fuel and maintenance of vehicles, perdiem of drivers).
The same vehicles transports vaccines and safety injection material together / Author's estimate as these costs are part of regular GHS budget at each level and are not differentiated.. / Authors assumptions based on Ministerio de saludAgostino (Lima) warehouse data and experts opinion (UNICEF Peru).
Cold chain costs – storage of vaccines (2-8°C) at central level / Authors’ estimate based on Central medical stores data includes only direct running costs (salary of staff, electricity and maintenance of walk-in cold rooms) / Author's estimate as these costs are part of regular GHS budget at each level and are not differentiated.. / PATH, 2009. Vaccine Presentation Assessment Tool
Dry storage costs at central level / Authors’ estimate based on Central medical stores data. Includes only direct running costs (salary of handlers working in these warehouses and electricity costs). / Author's estimate as these costs are part of regular GHS budget at each level and are not differentiated.. / Authors assumptions based on Ministerio de salud Agostino (Lima) warehouse data. Estimate include the following running costs of the national warehouse: operation costs (telephone, internet, office consumables), staff, energy, security, insurance, maintenance of the building.
Costs of contaminated waste collection and elimination / Authors estimate based on expert’s opinion (Cambodia Red Cross). Based on the monthly bill paid in 2013 by healthcenters in PnomPenh that have a contract for collection and elimination (incineration) of contaminated waste with CRC and the share of waste generated by pentavalent immunization in the total volume/weight of medical waste generated by a health centre. / Author's estimate as these costs are part of regular GHS budget at each level and are not differentiated. / Direccíon regional de salud de Huacho (Regional healthdirectorate of Huacho)
Ministerio de salud, Lima
Based on the actual contract costs in 2013 the regional hospital pays for the collection and elimination of medical waste to a private company.
Labour costs for nurse at health center per year / Expert’s opinion (Ministry of health, NIP). Costs include the average monthly wage and incentives/benefits perceived by nurses at health centers / Authors’ assumptions, based on general estimates from various GHS employees.. / Instituto Nacional de Salud, Peru. 2012
Evaluación del impacto económico de las alternativas de la vacunación con vacuna de polio inactivada y del esquema vacunal completo. Informe Técnico. Julio.
Number of worked days per year per health worker at health facility / Expert’s opinion (Ministry of health, NIP) considering health centers are open 7 days a week, health workers take shift and work 5 days/week plus 2 additional days per month, there are 25 public holidays / Ghana Health Service / Instituto Nacional de Salud,Peru.2012
Evaluación del impacto económico de las alternativas de la vacunación con vacuna de polio inactivada y del esquema vacunal completo. Informe Técnico. Julio.
Staff time for one injection with SDV/MDV and with cPAD / PATH, 2011 / PATH, 2011 / PATH, 2011
Start-up costs for cPAD – training of health staff / Expert’s opinion (WHO Cambodia). The estimate includes per diem, travel and accommodation expenses of participants, fees of facilitators and training rental of venue. / Ghana Health Service / Expert’s opinion (Direccion regional de saludHuacho): The estimate includes perdiem and travel and accommodation expenses of participants, fees of facilitators and rental of training venue.
Start-up costs for cPAD – supervision and monitoring and evaluation / Expert’s opinion (WHO Cambodia) / Ghana Health Service / Expert’sopinion (Estatégia nacional de inmunizaciones)

NIP national immunization plan, EPI expended program on immunization

The parameters considered in the sensitivity analysis (value ranges and distribution) are detailed in table 2.