Vial usage, device dead space, vaccine wastage, and dose accuracy of intradermal delivery devices for inactivated poliovirus vaccine (IPV)

Jarrahian, Courtney; Rein‐Weston, Annie; Saxon, Gene; Creelman, Ben; Kachmarik, Greg; Anand, Abhijeet; Zehrung, Darin

doi:10.1016/j.vaccine.2016.11.098

Cited by 26 publications

(22 citation statements)

References 29 publications

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“…10,11 The syringe "dead space" is the volume of residual fluid that remains within the hub after the plunger is fully depressed. 3 The International Organization for Standardization provides a standard for the design with the limitation of dead space derived from the nominal capacity of the syringe. 4 This concept was expanded upon with recognition of dead space being related to financial loss through insulin waste, as well as affecting the precision of insulin delivery.…”

Section: Discussionmentioning

confidence: 99%

The Association between Needle Size and Waste Product and Its Effect on Cost-Effectiveness of Botulinum Toxin Injections?

et al. 2020

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Clostridium botulinum toxin (BT) must be administered intramuscularly with a syringe, but dead space in the syringe–needle complex may cause product waste and result in cost implications for the patient and provider. Syringe dead space is the volume of residual fluid that remains within the syringe after the plunger is fully depressed during medication injection. We calculated the average volume of remaining product in a syringe–needle complex and cost loss implication of this volume of BT. This is a single-center, analytical study using saline and four different sized needles for analytics of waste product and cost-effectiveness. Syringes of 1 mL with attached 18, 21, 30, and 32-gauge (G) needles, respectively, were compared. The syringe–needle complex was weighed before drawing 0.05 mL of saline. The fluid was then discarded with the appropriate syringe and then weighed again. This procedure was repeated for the four needle types and the average difference in weight of the syringe–needle complex before and after saline waste was measured. The volume was converted to units of BT used in clinical practice and the cost of waste product evaluated. The mean difference in needle–syringe complex weight before and after intervention was 0.068, 0.056, 0.04, and 0.026 g for the 18, 21, 30, and 32G needles, respectively. We found a statistically significant difference comparing the 18G with the 30 and 32G (0.02 and 0.0007, respectively) and comparing the 21G with the 30 and 32G (0.0042 and 0.00002, respectively). When we extrapolated the data to BT units (4U/0.1 mL), we found that theoretically 2.72, 2.24, 1.6, and 1.04 units of BT are left in the syringe–needle complex for the 18, 21, 30, and 32G syringes, respectively. At a cost of $6.01/U of onabotulinum toxin A, we then calculated a provider loss of a gross average (mean) revenue of $96 and 62.4 per 10 syringes used with 30 and 32G needles. Needle size used for drawing up and administering BT has an effect on the amount of waste product and subsequently on cost-effectiveness.

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Section: Discussionmentioning

confidence: 99%

The Association between Needle Size and Waste Product and Its Effect on Cost-Effectiveness of Botulinum Toxin Injections?

et al. 2020

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“…We assumed lower open-vial vaccine wastage rates for smaller vial sizes, for full-dose delivery, and for campaign settings because open-vial wastage rates are affected by the number of doses in each vial and the number of children vaccinated at each session or during the 28-day period during which an opened IPV vial can be used under the Multi-dose Vial Policy [19]. For fractional doses, the price per dose also accounts for the fact that each full-dose equivalent can provide less or more than five fractional doses, depending on device design and the user’s technique when drawing doses [20]. Table 1 also shows the assumptions on vaccine wastage rates for different vial sizes and delivery settings.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2019

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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.

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“…In this way, it is imperative to avoid vaccine wastages by effectively use all doses available. Vaccine wastage can occur at multiple points during the preparation, filling, and inoculation processes, but it is mainly because the device dead space and filling process technique [10][11][12][13][14][15] : One vital device is an appropriate syringe-needle system for delivering the vaccine. The association between needle-syringe system and waste were previously reported 10,16,17 . However, there are no publications discussing the waste volume effect of COVID-19 vaccines in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Optimizing Covid-19 Vaccine Usage

Jara

Velloso

Araújo

2021

Preprint

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As the worldwide vaccination, it is imperative to minimize vaccine wastage by effectively using all doses available. Vaccine wastage can occur at multiple points during the vaccination process, but it is mainly because the device dead space and the filling process technique. However, there are no studies discussing the waste volume effect of COVID-19 vaccines in clinical practice. There is an increasing COVID-19 vaccine demand that we estimate up to several billion dual doses. The objective of this study was to assess the number of 0.3mL doses obtained from a multiple-dose vial using 1ml and 3ml syringes with different type of needles replicating the first COVID-19 vaccination protocol.Our results suggest that it is possible to obtain six or seven doses from each vial instead five. We provide evidence to optimize between 20% and 40% additional vaccine doses per vial if the current 5-dose vials are used, making scarce supplies go further.It is our duty, as researchers, to ensure the efficacy and efficiency of the worldwide COVID-19 vaccination process. However, if standard syringes-needles and technique are used, there may not be sufficient volume to draw extra doses from a single vial.

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Vial usage, device dead space, vaccine wastage, and dose accuracy of intradermal delivery devices for inactivated poliovirus vaccine (IPV)

Cited by 26 publications

References 29 publications

The Association between Needle Size and Waste Product and Its Effect on Cost-Effectiveness of Botulinum Toxin Injections?

The Association between Needle Size and Waste Product and Its Effect on Cost-Effectiveness of Botulinum Toxin Injections?

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

Optimizing Covid-19 Vaccine Usage

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