Evaluating the cost per child vaccinated with full versus fractional-dose inactivated poliovirus vaccine.
Abstract
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.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.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 $3.57 for full dose, when using 5-dose vials. The magnitude of cost reductions with fIPV relative to full-dose IPV was largest with smaller vial sizes and higher vaccine price.Adopting fIPV can reduce costs per child vaccinated compared with using full doses, especially as IPV prices increase in the short term and more so when two full doses could be recommended in the future.
Keywords
immunization
who, world health organization
ad, autodisable
bcg, bacillus calmette-guérin
cost per child
costing
fractional ipv
fractional dose
id, intradermal
im fipv, intramuscular administration of fractional doses of ipv
im, intramuscular
ipv, inactivated poliovirus vaccine
inactivated poliovirus vaccine
n&s, needle and syringe
opv, oral poliovirus vaccine
sage, strategic advisory group of experts
unicef, united nations children’s fund
us$, us dollars
vdpv, vaccine-derived poliovirus
bopv, bivalent oral poliovirus vaccine
cmyp, comprehensive multiyear plan for immunization
fipv, fractional-dose inactivated poliovirus vaccine
topv, trivalent oral poliovirus vaccine
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48649
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48649
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10.1016/j.jvacx.2019.100032
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