Abstract
IntroductionInactivated 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. MethodsWe 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. ResultsIn 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. ConclusionAdopting 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.
Highlights
Inactivated poliovirus vaccine (IPV) shortages and evidence of improved immunogenicity of two intradermal (ID) fractional IPV doses compared with one full intramuscular dose led to recommendations for fIPV delivery
Using 2019 IPV prices, the cost per child vaccinated with all doses in the schedule decreased as vaccine vial size increased across all administration methods (IM and ID) for both full and fractional doses (Fig. 2)
The costs, which included campaign operational costs, were highest for fulldose administration ($4.75) using single-dose vials and lowest for fractional dosing using 10-dose vials administered with ID needle and syringe (N&S) ($1.61)
Summary
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. Commodity costs included vaccine price per dose adjusted for wastage, prices for vaccine administration devices, and safety boxes. 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. Costs per child fully vaccinated with fractional doses were 15% to 48% lower than those with full-dose delivery across different vial sizes. 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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