Title
Can a compact prefilled auto-disable injection system (cPAD) save costs for DTP-HepB-Hib vaccine
as compared to single-dose (SDV) and multi-dose vials (MDV)? Evidence from Cambodia, Ghana and
Peru.
Journal
Drugs: Real World Outcomes
Authors names
Cyril Nogier, Patrick Hanlon, Karin Wiedenmayer, Nicolas Maire
Affiliation and e-mail address of the corresponding author
Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002 Basel, Switzerland
cyril.nogier@unibas.ch
Table 6 : Source of parameter values and their estimation mode
Parameters in the
model
Cambodia
Ghana
Peru
Time horizon
NIP strategic plan
2013-2020
EPI planning horizon of
five years
Strategic plan of the
Estratégia nacional de
inmunizaciones (ESNI)
Population at start
year
Statistics Bureau,
Ministry of Internal
Affairs and
communications, japan
http://www.stat.go.jp/inf
o/meetings/cambodia/p
df/rp12_ch10.pdf
Immunization Program
Comprehensive MultiYear Plan 2010-2014
revised May 2011
Estado de la población
peruana 2012.Instituto
Nacional de
Estadísticas
Informática. Julio 2012
Birth rate 2011
(natality)
United Nations. World
Population Prospects.
The 2012 Revision.
Immunization Program
Comprehensive MultiYear Plan 2010-2014
revised May 2011
http://www.inei.gob.pe/
Sisd/index.asp
Growth rate of
population for
2013-2017
United Nations. World
Population Prospects.
The 2012 Revision.
Immunization Program
Comprehensive MultiYear Plan 2010-2014
revised May 2011
http://www.inei.gob.pe/
Sisd/index.asp
Immunization
coverage of the
pentavalent
Ministry of health, 2012
Ghana Health Service
2011 Annual Report
WHO statistics, 2012
http://apps.who.int/imm
unization_monitoring/e
n/globalsummary/count
ryprofileresult.cfm?c=p
er
Number of
pentavalent
injections in
children 0 -1 year
old
Cambodia
Immunization schedule,
2013 NIP
Ghana Health Service,
Immunization Program
Comprehensive MultiYear Plan (2010-2014)
Peruvian Ministry of
health immunization
schedule
Price of
pentavalent in
SDV- FCA
The vaccine prices
used in the model are
expected prices in
2016 comparable to
major procurement
prices. Personal
communication with the
pentavalent vaccine
manufacturer in SDV.
UNICEF_2013_DTPHepB-Hib.pdf lowest
price for 2016 from
Serum Institute of India
Ltd.
The vaccine prices
used in the model are
expected prices in
2016 comparable to
major procurement
prices. Personal
communication with the
pentavalent vaccine
manufacturer in SDV.
Price of
pentavalent in
cPAD - FCA
The vaccine prices
used in the model are
expected prices in
2016 comparable to
major procurement
prices. Personal
communication with the
pentavalent vaccine
manufacturer (that
plans to launch cPAD).
The vaccine prices
used in the model are
expected prices in
2016 comparable to
major procurement
prices. Personal
communication with the
pentavalent vaccine
manufacturer (that
plans to launch cPAD)..
The prices used in the
model are expected
prices in 2016
comparable to major
procurement prices.
Personal
communication with the
pentavalent vaccine
manufacturer (that
plans to launch cPAD)..
Taxes on FCA for
vaccine procured
through UNICEF
Personal
communication with
NIP, 02.2013
Procurement Manager,
Ghana Health Service
(GHS)
Instituto Nacional de
Salud, 2012
Parameters in the
model
Cambodia
Ghana
Peru
Price of syringes
0.5 ml (AD, 25 G *
1”) – FCA
www.unicef.org/supply/i
ndex_immunization.ht
ml /
UNICEF Autodisable_AD_syringes_a
nd_Safety_Boxes_pric
e_data.pdf (UNICEF
2012)
www.unicef.org/supply/i
ndex_immunization.ht
ml/
UNICEF Autodisable_AD_syringes_a
nd_Safety_Boxes_pric
e_data.pdf (UNICEF
2012)
Instituto Nacional de
Salud, 2012
Price of safety
boxes (5 l) - FCA
www.unicef.org/supply/i
ndex_immunization.ht
ml /
UNICEF Autodisable_AD_syringes_a
nd_Safety_Boxes_pric
e_data.pdf (UNICEF
2012)
www.unicef.org/supply/i
ndex_immunization.ht
ml /
UNICEF Autodisable_AD_syringes_a
nd_Safety_Boxes_pric
e_data.pdf (UNICEF
2012)
www.unicef.org/supply/i
ndex_immunization.ht
ml /
UNICEF Autodisable_AD_syringes_a
nd_Safety_Boxes_pric
e_data.pdf (UNICEF
2012)
Taxes on FCA for
safe injection
procured through
UNICEF
Personal
communication with
NIP, 02.2013
Procurement Manager,
Ghana Health Service.
Instituto Nacional de
Salud, 2012
Procurement
management costs
in %
Personal
communication with
NIP, 02.2013
None
Personal
communication with
ESNI, 12.2012
Volume of the
pentavalent in
SDV or MDV
format
SDV format: personal
communication with
Crucell on 10.2012
MDV-10 format per
dose:
www.jhsph.edu/.../Kone
Vaccine_Characteristic
s
SDV format: personal
communication with
Crucell on 10.2012
Volume of the
pentavalent in
cPAD
Personal
communication with
Crucell on 10.2012
Personal
communication with
Crucell on 10.2012
Personal
communication with
Crucell on 10.2012
Volume of the
syringes
PQS device catalogue,
2012. E008 p. 165
http://apps.who.int/imm
unization_standards/va
ccine_quality/pqs_catal
ogue/
PQS device catalogue,
2012 .E008 p. 165
http://apps.who.int/imm
unization_standards/va
ccine_quality/pqs_catal
ogue/
Personal
communication with
Vanish Point, 01.2013
Volume of the
safety boxes (5 l) –
packed
WHO vaccine volume
calculator 2012
WHO Vaccine Volume
Calculator 2012
WHO vaccine volume
calculator 2012
Weight of the
safety boxes (5 l)
WHO vaccine volume
calculator 2012
WHO vaccine volume
calculator 2012
WHO vaccine volume
calculator 2012
Put complete reference
Put complete reference
WHO, 2000
WHO, 2000
Wastage rate of
pentavalent in
SDV
Ministry of Health, 2012
Put complete reference
Parameters in the
model
Cambodia
Ghana
Peru
Wastage rate of
pentavalent in
cPAD
Sutanto et al., 2009
Sutanto et al., 2009
Sutanto et al., 2009
Wastage rate of
syringes and
safety boxes (5 l)
WHO, 2002. Guidelines
for estimating costs of
introducing new
vaccines into the nation
immunization system.
WHO, 2002. Guidelines
for estimating costs of
introducing new
vaccines into the nation
immunization system.
WHO, 2002. Guidelines
for estimating costs of
introducing new
vaccines into the nation
immunization system.
Number of
syringes per safety
box (5l)
PATH 2012, Planning
for the Introduction of
Quinvaxem in Uniject.
Healthcare Waste
Management
Considerations. Draft
report. Unpublished
PATH 2012, Planning
for the Introduction of
Quinvaxem in Uniject.
Healthcare Waste
Management
Considerations. Draft
report. Unpublished
Personal
communication with
VanishPoint
corporation, 10.2013
Number of cPAD
devices per safety
box (5l)
PATH 2012, Planning
for the Introduction of
Quinvaxem in Uniject.
Healthcare Waste
Management
Considerations. Draft
report. Unpublished
PATH 2012, Planning
for the Introduction of
Quinvaxem in Uniject.
Healthcare Waste
Management
Considerations. Draft
report. Unpublished
PATH Draft Dec. 15th,
2012 PATH (2012).
Unpublished
Weight of the
pentavalent in
cPAD (filled /
empty)
Personal
communication with
Crucell on 10.2012
Personal
communication with
Crucell on 10.2012
Personal
communication with
Crucell on 10.2012
Weight of the
pentavalent (filled /
empty vial)
Personal
communication with
Crucell on 10.2012
(SDV)
Lee et al, 2010. (empty
vial)
Authors’ estimates (full
vial)
(MDV)
Personal
communication with
Crucell on 10.2012
(SDV)
Weight of syringes
Secondary
packaging an
syringe alone
Personal
communication with
Becton Dickinson,
12.2013
Personal
communication with
Becton Dickinson,
12.2013
Personal
communication with
Vanish point
corporation, 10.2013
Volume of the
safety box (5l) unpacked
WHO vaccine volume
calculator, 2012
WHO vaccine volume
calculator, 2012
WHO vaccine volume
calculator, 2012
Parameters in the
model
Cambodia
Ghana
Peru
Transportation
costs of vaccine
from central to
provincial level
Authors’ estimate
based on Central
medical stores (CMS)
data on annual
recurrent costs born for
the distribution of all
EPI vaccines/safe
injection material
including
by CMS including (fuel
and maintenance of
vehicles, perdiem of
drivers).
The same vehicle
transports vaccines
and safety injection
material together,
Author's estimate as
these costs are part of
regular GHS budget at
each level and are not
differentiated..
Experts’ opinion
(UNICEF Peru). Based
on estimates of the
contract costs of the
MoH MoH, Directorate
of Supply of strategic
health resources
(DARES), that
contracts local
transporters (by air or
ground) that ship
vaccines to regional
level based on the
weight of vaccines.
Transportation
costs – not
refrigerated from
central to
provincial al level
Authors’ estimate
based on Central
medical stores (CMS)
data on annual
recurrent costs born for
the distribution of all
EPI vaccines/safe
injection material
including
by CMS including (fuel
and maintenance of
vehicles, perdiem of
drivers).
The same vehicles
transports vaccines
and safety injection
material together
Author's estimate as
these costs are part of
regular GHS budget at
each level and are not
differentiated..
Authors assumptions
based on Ministerio de
salud Agostino (Lima)
warehouse data and
experts opinion
(UNICEF Peru).
Cold chain costs –
storage of
vaccines (2-8°C)
at central level
Authors’ estimate
based on Central
medical stores data
includes only direct
running costs (salary of
staff, electricity and
maintenance of walk-in
cold rooms)
Author's estimate as
these costs are part of
regular GHS budget at
each level and are not
differentiated..
PATH, 2009. Vaccine
Presentation
Assessment Tool
Parameters in the
model
Cambodia
Ghana
Peru
Dry storage costs
at central level
Authors’ estimate
based on Central
medical stores data.
Includes only direct
running costs (salary of
handlers working in
these warehouses and
electricity costs).
Author's estimate as
these costs are part of
regular GHS budget at
each level and are not
differentiated..
Authors assumptions
based on Ministerio de
salud Agostino (Lima)
warehouse data.
Estimate include the
following running costs
of the national
warehouse: operation
costs (telephone,
internet, office
consumables), staff,
energy, security,
insurance,
maintenance of the
building.
Costs of
contaminated
waste collection
and elimination
Authors estimate based
on expert’s opinion
(Cambodia Red Cross).
Based on the monthly
bill paid in 2013 by
health centers in Pnom
Penh that have a
contract for collection
and elimination
(incineration) of
contaminated waste
with CRC and the
share of waste
generated by
pentavalent
immunization in the
total volume/weight of
medical waste
generated by a health
centre.
Author's estimate as
these costs are part of
regular GHS budget at
each level and are not
differentiated.
Direccíon regional de
salud de Huacho
(Regional health
directorate of Huacho)
Ministerio de salud,
Lima
Based on the actual
contract costs in 2013
the regional hospital
pays for the collection
and elimination of
medical waste to a
private company.
Parameters in the
model
Cambodia
Ghana
Peru
Labour costs for
nurse at health
center per year
Expert’s opinion
(Ministry of health,
NIP). Costs include the
average monthly wage
and incentives/benefits
perceived by nurses at
health centers
Authors’ assumptions,
based on general
estimates from various
GHS employees..
Instituto Nacional de
Salud, Peru. 2012
Evaluación del impacto
económico de las
alternativas de la
vacunación con vacuna
de polio inactivada y del
esquema vacunal
completo. Informe
Técnico. Julio.
Number of worked
days per year per
health worker at
health facility
Expert’s opinion
(Ministry of health, NIP)
considering health
centers are open 7
days a week, health
workers take shift and
work 5 days/week plus
2 additional days per
month, there are 25
public holidays
Ghana Health Service
Instituto Nacional de
Salud, Peru. 2012
Evaluación del impacto
económico de las
alternativas de la
vacunación con vacuna
de polio inactivada y del
esquema vacunal
completo. Informe
Técnico. Julio.
Staff time for one
injection with
SDV/MDV and with
cPAD
PATH, 2011
PATH, 2011
PATH, 2011
Start-up costs for
cPAD – training of
health staff
Expert’s opinion (WHO
Cambodia). The
estimate includes per
diem, travel and
accommodation
expenses of
participants, fees of
facilitators and training
rental of venue.
Ghana Health Service
Expert’s opinion
(Direccion regional de
salud Huacho): The
estimate includes
perdiem and travel and
accommodation
expenses of
participants, fees of
facilitators and rental of
training venue.
Start-up costs for
cPAD –
supervision and
monitoring and
evaluation
Expert’s opinion (WHO
Cambodia)
Ghana Health Service
Expert’s opinion
(Estatégia nacional de
inmunizaciones)
NIP national immunization plan, EPI expended program on immunization
The parameters considered in the sensitivity analysis (value ranges and distribution) are detailed in
table 2.