CHAMPAIGN, Ill. — Four infant vaccines. One injection. How much will the industry charge? How much is a parent willing to pay? How much will government and insurance cover? Such issues are becoming real, says a University of Illinois researcher who has developed a mathematically based analysis tool to help pinpoint acceptable pricing.
“If you look around the world right now, combination vaccines are being used in Canada and Europe with tremendous success,” said Sheldon H. Jacobson, a professor of mechanical and industrial engineering in the UI College of Engineering. “We initially analyzed the value of four particular combination vaccines, but our tool is really applicable to any combination, and there are several now on the horizon of reaching the FDA for approval. Such approval is going to happen.”
With National Infant Immunization Week being April 14-20 in the United States, many parents and children may be more concerned about painful memories of injections than about the benefits gained by childhood immunizations, Jacobson said.
His analysis tool incorporates a Monte Carlo simulation and an integer programming model, allowing researchers to study the various relationships of vaccine costs and any number of individual factors, including individual and societal benefits. The tool – described in the April issue of Health Care Management Science – computes an optimum price for a combination vaccine to meet a manufacturer’s targeted market share.
Primary concerns for parents, Jacobson said, are the costs of injections, the number required per office visit and the pain associated with each injection. Many parents, fearing that four recommended shots at one visit are too many, choose to get two for their child at one office visit and return later, but they don’t follow through. Non-compliance can lead to a resurgence of the very diseases the immunizations protect against.
A pilot study by Jacobson, in which he weighed the economic value of combining vaccines to reduce the number of injections or clinical visits, was published in 1998. Since then, he has increased the model’s capabilities to encompass any number of considerations. Edward C. Sewell of Southern Illinois University was co-author of the new study.
“The bottom line is that combination vaccines do provide an economic value,” Jacobson said. “The model that we have developed allows vaccine manufacturers to understand what that value is, but more importantly it allows for the inclusion of concerns of health-care consumers, the insurance industry and government so that they do not overpay. We can sit down with all parties and plug in the variables that they identify.
“We can be a mediator and come up with a price that both sides can live with,” he said. “They may not all like our results, but the model is a tool with no emotion. They tell us what data to put in, and we’ll run the numbers.”
The new study focused on four combination vaccines that eventually may become available for distribution in the United States, with each combination configured with the 12 licensed vaccines now being used for six childhood diseases in the Recommended Childhood Immunization Schedule. Rather than finding a single price, the tool considers any number of cost-associated factors and finds a distribution of prices that match a manufacturer’s target market percentages and what consumers will pay.
The 2002 immunization schedule is crowded, with up to five injections recommended at a single office visit. As manufacturers produce new vaccines to protect against additional diseases, pressure mounts to add those vaccines to the immunization schedule.
In 1999, the Advisory Committee on Immunization Practices, the American Academy of Pediatrics and the American Academy of Family Physicians stated that combination vaccines are preferable to single-antigen vaccines and that physicians should begin using those that gain FDA approval.
Journal
Health Care Management Science