Abstract
BackgroundLittle is known on the economic implications of multi-dose 13 valent pneumococcal conjugate vaccine (PCV13) introduction in expanded program on immunization (EPI). Based on evidence of PCV13’s reduced pressure on vaccine cold chain, Benin, a third world country in West Africa, introduced the multi-dose PCV13 starting in April 2018 in its EPI program in replacement of the single-dose presentation. The objective of this study was to conduct a rapid assessment of the costs and economic impact of switching from single- to multi-dose PCV13 vial in Benin.MethodsThe data collected retrospectively between January 1 and February 16, 2019 using a quantitative questionnaire was analyzed using Excel 2010 and Stata 13. Resources consumed from April 1st to September 30th, 2017 for the single-dose PCV13 and from April 1st to September 30th, 2018 for multi-dose were analyzed. For both presentations, costs analyzed included vaccines, injections supplies, waste management, cold chain, personnel (salaries and per diems), supervision and monitoring, training, social mobilization and overheads. Moreover, additional costs incurred for the introduction of multi-dose PCV13 were also collected. Costs were estimated for each presentation of PCV13 vaccine by calculating the half-year value of recurrent and capital costs, discounted at a rate of 3% for capital items. To enable comparisons, costs pertaining to 2017 were converted to 2018 equivalent values taking inflation in US$ into account.ResultsThe economic costs of the single-dose PCV13 exceeded that of the multi-dose: US$ 3,708,795 versus US$ 3,698,795, respectively. Three cost items, including costs of vaccines, injection supplies, and cold chain appeared to be the main drivers of the observed reduction in costs of multi-dose PCV13. Moreover, the cost per infant vaccinated was lower with the single-dose PCV13 than the multi-dose, respectively US$ 6.28 versus US$ 10.92, and costs of vaccines wasted higher for the multi-dose PCV13.ConclusionsThis evaluation seemed to show that the switch from single- to multi-dose PCV13 resulted in reduced economic costs of PCV13. Vaccinating more infants together with a rigorous application of vaccine open vial policy could lead to the change being more cost-effective.
Highlights
Little is known on the economic implications of multi-dose 13 valent pneumococcal conjugate vaccine (PCV13) introduction in expanded program on immunization (EPI)
Annualized, half-yearly economic costs of 13-valent pneumococcal vaccine (PCV13) The annualized economic costs of the single-dose PCV13 were slightly higher than the multi-dose PCV13: $3,708,795 Vs $3,698,935 (Table 1)
Of the multi-dose PCV13 total costs, annual one-time costs incurred for the introduction of the new vaccine was $308,422, equivalent to 8.34% of the total economic costs of multidose PCV13
Summary
Little is known on the economic implications of multi-dose 13 valent pneumococcal conjugate vaccine (PCV13) introduction in expanded program on immunization (EPI). Upon its prequalification by WHO, and eligibility for GAVI support, Benin’s introduced the multi-dose PCV13 in its Expanded Program on Immunization (EPI) in April 2018. This introduction was prompted by the evidence suggesting a reduced pressure of the multidose PCV13 on vaccine cold chain, consisting of intertwined links that are designed to keep vaccines within WHO recommended temperature ranges, from the point of manufacture to the point of delivery. It may consist in the introduction of a new formulation of a vaccine already present in the EPI program, or a combination vaccine replacing an old vaccine, or the replacement of a vaccine presentation by another presentation of the same vaccine
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