Evaluating the cost per child vaccinated with full versus fractional-dose inactivated poliovirus vaccine

Abstract

Introduction Inactivated poliovirus vaccine (IPV) shortages and evidence of improved immunogenicity of two intradermal (ID) fractional IPV (fIPV) doses compared with one full intramuscular dose led to recommendations for fIPV delivery. To provide evidence on the economics of fIPV, we estimated the cost per child vaccinated using full-dose IPV compared with fIPV in routine and campaign settings. We evaluated the impact on costs of alternative devices facilitating ID administration, vaccine vial sizes, and prices. Methods We used an Excel-based model to estimate the commodity and delivery costs for providing IPV. Commodity costs included vaccine price per dose adjusted for wastage, prices for vaccine administration devices, and safety boxes. Delivery costs included storage costs at each level of the supply chain, transport costs for commodities between levels, and human resource costs for vaccine administration. Model inputs were obtained from various databases and published literature. All costs are reported in 2018 US dollars. Results In both campaign and routine settings, fIPV had a lower cost per child vaccinated than full dosing, despite the assumed higher vaccine wastage with fIPV in routine settings, and even when novel ID administration devices were used. In routine settings, costs per child fully vaccinated with fractional doses were 15% to 48% lower than those with full-dose delivery across different vial sizes. The cost per child vaccinated ranged from $1.84 to $2.65 for fractional doses, depending on the administration device, compared with $3.57 for full dose, when using 5-dose vials. The magnitude of cost reductions with fIPV relative to full-dose IPV was largest with smaller vial sizes and higher vaccine price. Conclusion Adopting fIPV can reduce costs per child vaccinated compared with using full doses, especially as IPV prices increase in the short term and more so when two full doses could be recommended in the future.

Review of poliovirus modeling performed from 2000 to 2019 to support global polio eradication

“…Questions also remain about the formulations of IPV vaccine that may become available in the future, which will affect future poliovirus vaccine policy modeling and the path of the polio endgame [240]. Currently, most OPV-using countries deliver stand-alone formulations of IPV, although in some cases they use off-label fractional intradermal delivery, which can save substantially on antigen costs, but cost more with respect to administration [230]. Research underway may also provide an IPV vaccine patch option [242][243][244][245], which would potentially achieve both dose-sparing of IPV and ease of delivery that could increase coverage, albeit at a potentially higher and uncertain cost.…”

“…Finally, the search captured a 2017 study that reported on the GPEI costs associated with supporting tOPV-using countries as they switched to bOPV [ 179 ]. The search did not capture a 2019 study that reported the cost per child vaccinated with full versus fractional-dose IPV [ 230 ].…”

Strategies for vaccine-product innovation: Creating an enabling environment for product development to uptake in low- and middle-income countries

“…In addition, the use of needles and syringes for administration was associated with the potential for needle re-use. Over past decades, there have been efforts to develop and implement new vaccine-product innovations to overcome some of these delivery and administration barriers and four are described in these case studies ( Box 1 , Box 2 , Box 3 , Box 4 , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [17] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [15] , [16] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] ).…”

Potential Future Use, Costs, and Value of Poliovirus Vaccines

“…The historical cost estimates for poliovirus vaccines in Table I do not account for some of the products that have entered or may enter the market. In addition, for prospective health economic analyses, we also recognize the opportunity to make adjustments based on updated price estimates from the UNICEF supply division (UNICEF, 2019), policies that affect wastage assumptions (World Health Organization, 2014b), information about the costs of new products (Leo, 2019; Mvundura et al., 2019), and the need to consider the implications of updated guidelines and recommendations (World Health Organization, 2019b).…”

“…Table I summarizes estimates of polio vaccine cost and valuation inputs for different income levels based on prior analyses and useful for retrospective economic analyses for 1988-2018(Duintjer Tebbens & Thompson, 2016Duintjer Tebbens et al, 2011;Duintjer Tebbens, Pallansch, Wassalik, et al, 2015;Duintjer Tebbens, Sangrujee, & Thompson, 2006;Thompson & Duintjer Tebbens, 2014;Thompson et al, 2008) Thompson, 2016;Duintjer Tebbens et al, 2011;Duintjer Tebbens, Pallansch, et al, 2006;Duintjer Tebbens, Pallansch, Wassalik, et al, 2015;Thompson & Duintjer Tebbens, 2014;Thompson et al, 2008 The historical cost estimates for poliovirus vaccines in Table I do not account for some of the products that have entered or may enter the market. In addition, for prospective health economic analyses, we also recognize the opportunity to make adjustments based on updated price estimates from the UNICEF supply division (UNICEF, 2019), policies that affect wastage assumptions (World Health Organization, 2014b), information about the costs of new products (Leo, 2019;Mvundura et al, 2019), and the need to consider the implications of updated guidelines and recommendations (World Health Organization, 2019b).…”