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Tove K. Ryman - One of the best experts on this subject based on the ideXlab platform.
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Vaccine Wastage in Nigeria: An assessment of Wastage rates and related vaccinator knowledge, attitudes and practices.
Vaccine, 2017Co-Authors: Aaron S. Wallace, Fred Willis, Eric Nwaze, Boubacar Dieng, Naawa Sipilanyambe, Danni Daniels, Emmanuel Abanida, Alex Gasasira, Mustapha Mahmud, Tove K. RymanAbstract:The introduction of new vaccines highlights concerns about high vaccine Wastage, knowledge of Wastage policies and quality of stock management. However, an emphasis on minimizing Wastage rates may cause confusion when recommendations are also being made to reduce missed opportunities to routinely vaccinate children. This concern is most relevant for lyophilized vaccines without preservatives [e.g. measles-containing vaccine (MCV)], which can be used for a limited time once reconstituted. We sampled 54 health facilities within 11 local government areas (LGAs) in Nigeria and surveyed health sector personnel regarding routine vaccine usage and Wastage-related knowledge and practices, conducted facility exit interviews with caregivers of children about missed opportunities for routine vaccination, and abstracted vaccine stock records and vaccination session data over a 6-month period to calculate Wastage rates and vaccine vial usage patterns. Nearly half of facilities had incomplete vaccine stock data for calculating Wastage rates. Among facilities with sufficient data, mean monthly facility-level Wastage rates were between 18 and 35% across all reviewed vaccines, with little difference between lyophilized and liquid vaccines. Most (98%) vaccinators believed high Wastage led to recent vaccine stockouts, yet only 55% were familiar with the multi-dose vial policy for minimizing Wastage. On average, vaccinators reported that a minimum of six children must be present prior to opening a 10-dose MCV vial. Third dose of diphtheria-tetanus-pertussis vaccine (DTP3) was administered in 84% of sessions and MCV in 63%; however, the number of MCV and DTP3 doses administered were similar indicating the number of children vaccinated with DTP3 and MCV were similar despite less frequent MCV vaccination opportunities. Among caregivers, 30% reported being turned away for vaccination at least once; 53% of these children had not yet received the missed dose. Our findings show inadequate implementation of vaccine management guidelines, missed opportunities to vaccinate, and lyophilized vaccine Wastage rates below expected rates. Missed opportunities for vaccination may occur due to how the health system's contradicting policies may force health workers to prioritize reduced Wastage rates over vaccine administration, particularly for multi-dose vials. Published by Elsevier Ltd.
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Vaccine Wastage in Nigeria: An assessment of Wastage rates and related vaccinator knowledge, attitudes and practices
Vaccine, 2017Co-Authors: Aaron S. Wallace, Fred Willis, Eric Nwaze, Boubacar Dieng, Naawa Sipilanyambe, Danni Daniels, Emmanuel Abanida, Alex Gasasira, Mustapha Mahmud, Tove K. RymanAbstract:Abstract Introduction The introduction of new vaccines highlights concerns about high vaccine Wastage, knowledge of Wastage policies and quality of stock management. However, an emphasis on minimizing Wastage rates may cause confusion when recommendations are also being made to reduce missed opportunities to routinely vaccinate children. This concern is most relevant for lyophilized vaccines without preservatives [e.g. measles-containing vaccine (MCV)], which can be used for a limited time once reconstituted. Methods We sampled 54 health facilities within 11 local government areas (LGAs) in Nigeria and surveyed health sector personnel regarding routine vaccine usage and Wastage-related knowledge and practices, conducted facility exit interviews with caregivers of children about missed opportunities for routine vaccination, and abstracted vaccine stock records and vaccination session data over a 6-month period to calculate Wastage rates and vaccine vial usage patterns. Results Nearly half of facilities had incomplete vaccine stock data for calculating Wastage rates. Among facilities with sufficient data, mean monthly facility-level Wastage rates were between 18 and 35% across all reviewed vaccines, with little difference between lyophilized and liquid vaccines. Most (98%) vaccinators believed high Wastage led to recent vaccine stockouts, yet only 55% were familiar with the multi-dose vial policy for minimizing Wastage. On average, vaccinators reported that a minimum of six children must be present prior to opening a 10-dose MCV vial. Third dose of diphtheria-tetanus-pertussis vaccine (DTP3) was administered in 84% of sessions and MCV in 63%; however, the number of MCV and DTP3 doses administered were similar indicating the number of children vaccinated with DTP3 and MCV were similar despite less frequent MCV vaccination opportunities. Among caregivers, 30% reported being turned away for vaccination at least once; 53% of these children had not yet received the missed dose. Discussion Our findings show inadequate implementation of vaccine management guidelines, missed opportunities to vaccinate, and lyophilized vaccine Wastage rates below expected rates. Missed opportunities for vaccination may occur due to how the health system’s contradicting policies may force health workers to prioritize reduced Wastage rates over vaccine administration, particularly for multi-dose vials.
Kelvin K W Chan - One of the best experts on this subject based on the ideXlab platform.
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The impact of cancer drug Wastage on economic evaluations.
Cancer, 2017Co-Authors: Judy Truong, Matthew C Cheung, Helen Mai, Jessa Letargo, Alexandra Chambers, Mona Sabharwal, Maureen E. Trudeau, Kelvin K W ChanAbstract:BACKGROUND The objective of this study was to determine the impact of modeling cancer drug Wastage in economic evaluations because Wastage can result from single-dose vials on account of body surface area– or weight-based dosing. METHODS Intravenous chemotherapy drugs were identified from the pan-Canadian Oncology Drug Review (pCODR) program as of January 2015. Economic evaluations performed by drug manufacturers and pCODR were reviewed. Cost-effectiveness analyses and budget impact analyses were conducted for no-Wastage and maximum-Wastage scenarios (ie, the entire unused portion of the vial was discarded at each infusion). Sensitivity analyses were performed for a range of body surface areas and weights. RESULTS Twelve drugs used for 17 indications were analyzed. Wastage was reported (ie, assumptions were explicit) in 71% of the models and was incorporated into 53% by manufacturers; this resulted in a mean incremental cost-effectiveness ratio increase of 6.1% (range, 1.3%-14.6%). pCODR reported and incorporated Wastage for 59% of the models, and this resulted in a mean incremental cost-effectiveness ratio increase of 15.0% (range, 2.6%-48.2%). In the maximum-Wastage scenario, there was a mean increase in the incremental cost-effectiveness ratio of 24.0% (range, 0.0%-97.2%), a mean increase in the 3-year total incremental budget costs of 26.0% (range, 0.0%-83.1%), and an increase in the 3-year total incremental drug budget cost of approximately CaD $102 million nationally. Changing the mean body surface area or body weight caused 45% of the drugs to have a change in the vial size and/or quantity, and this resulted in increased drug costs. CONCLUSIONS Cancer drug Wastage can increase drug costs but is not uniformly modeled in economic evaluations. Cancer 2017. © 2017 American Cancer Society.
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financial impact of cancer drug Wastage and potential cost savings from mitigation strategies
Journal of Oncology Practice, 2017Co-Authors: Caitlyn Y W Leung, Matthew C Cheung, Lauren F Charbonneau, Anca Prica, Kelvin K W ChanAbstract:Purpose:Cancer drug Wastage occurs when a parenteral drug within a fixed vial is not administered fully to a patient. This study investigated the extent of drug Wastage, the financial impact on the hospital budget, and the cost savings associated with current mitigation strategies.Methods:We conducted a cross-sectional study in three University of Toronto–affiliated hospitals of various sizes. We recorded the actual amount of drug wasted over a 2-week period while using current mitigation strategies. Single-dose vial cancer drugs with the highest Wastage potentials were identified (14 drugs). To calculate the hypothetical drug Wastage with no mitigation strategies, we determined how many vials of drugs would be needed to fill a single prescription.Results:The total drug costs over the 2 weeks ranged from $50,257 to $716,983 in the three institutions. With existing mitigation strategies, the actual drug Wastage over the 2 weeks ranged from $928 to $5,472, which was approximately 1% to 2% of the total drug ...
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adjusting for drug Wastage in economic evaluations of new therapies for hematologic malignancies a systematic review
Journal of Oncology Practice, 2016Co-Authors: Karen Lien, Matthew C Cheung, Kelvin K W ChanAbstract:Purpose:As costs of cancer care rise, there has been a shift to focus on value. Drug Wastage affects costs to patients and health care systems without adding value. Historically, cost-effectiveness analyses have used models that assume no drug Wastage; however, this may not reflect real-world practices. We sought to identify the frequency of drug Wastage modeling in economic evaluations of modern parenteral therapies for hematologic malignancies.Methods:We conducted a systematic literature review of economic evaluations of new US Food and Drug Administration–approved parenteral chemotherapies with indications for the treatment of hematologic malignancies. The primary outcome of interest was the proportion of studies that modeled drug Wastage in base-case analyses. If Wastage was considered in primary analyses, we reported the impact of Wastage on incremental cost-effectiveness ratios (ICERs) and drug acquisition costs.Results:Wastage was considered in base-case analyses in less than one third of all publi...
Aaron S. Wallace - One of the best experts on this subject based on the ideXlab platform.
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Vaccine Wastage in Nigeria: An assessment of Wastage rates and related vaccinator knowledge, attitudes and practices.
Vaccine, 2017Co-Authors: Aaron S. Wallace, Fred Willis, Eric Nwaze, Boubacar Dieng, Naawa Sipilanyambe, Danni Daniels, Emmanuel Abanida, Alex Gasasira, Mustapha Mahmud, Tove K. RymanAbstract:The introduction of new vaccines highlights concerns about high vaccine Wastage, knowledge of Wastage policies and quality of stock management. However, an emphasis on minimizing Wastage rates may cause confusion when recommendations are also being made to reduce missed opportunities to routinely vaccinate children. This concern is most relevant for lyophilized vaccines without preservatives [e.g. measles-containing vaccine (MCV)], which can be used for a limited time once reconstituted. We sampled 54 health facilities within 11 local government areas (LGAs) in Nigeria and surveyed health sector personnel regarding routine vaccine usage and Wastage-related knowledge and practices, conducted facility exit interviews with caregivers of children about missed opportunities for routine vaccination, and abstracted vaccine stock records and vaccination session data over a 6-month period to calculate Wastage rates and vaccine vial usage patterns. Nearly half of facilities had incomplete vaccine stock data for calculating Wastage rates. Among facilities with sufficient data, mean monthly facility-level Wastage rates were between 18 and 35% across all reviewed vaccines, with little difference between lyophilized and liquid vaccines. Most (98%) vaccinators believed high Wastage led to recent vaccine stockouts, yet only 55% were familiar with the multi-dose vial policy for minimizing Wastage. On average, vaccinators reported that a minimum of six children must be present prior to opening a 10-dose MCV vial. Third dose of diphtheria-tetanus-pertussis vaccine (DTP3) was administered in 84% of sessions and MCV in 63%; however, the number of MCV and DTP3 doses administered were similar indicating the number of children vaccinated with DTP3 and MCV were similar despite less frequent MCV vaccination opportunities. Among caregivers, 30% reported being turned away for vaccination at least once; 53% of these children had not yet received the missed dose. Our findings show inadequate implementation of vaccine management guidelines, missed opportunities to vaccinate, and lyophilized vaccine Wastage rates below expected rates. Missed opportunities for vaccination may occur due to how the health system's contradicting policies may force health workers to prioritize reduced Wastage rates over vaccine administration, particularly for multi-dose vials. Published by Elsevier Ltd.
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Vaccine Wastage in Nigeria: An assessment of Wastage rates and related vaccinator knowledge, attitudes and practices
Vaccine, 2017Co-Authors: Aaron S. Wallace, Fred Willis, Eric Nwaze, Boubacar Dieng, Naawa Sipilanyambe, Danni Daniels, Emmanuel Abanida, Alex Gasasira, Mustapha Mahmud, Tove K. RymanAbstract:Abstract Introduction The introduction of new vaccines highlights concerns about high vaccine Wastage, knowledge of Wastage policies and quality of stock management. However, an emphasis on minimizing Wastage rates may cause confusion when recommendations are also being made to reduce missed opportunities to routinely vaccinate children. This concern is most relevant for lyophilized vaccines without preservatives [e.g. measles-containing vaccine (MCV)], which can be used for a limited time once reconstituted. Methods We sampled 54 health facilities within 11 local government areas (LGAs) in Nigeria and surveyed health sector personnel regarding routine vaccine usage and Wastage-related knowledge and practices, conducted facility exit interviews with caregivers of children about missed opportunities for routine vaccination, and abstracted vaccine stock records and vaccination session data over a 6-month period to calculate Wastage rates and vaccine vial usage patterns. Results Nearly half of facilities had incomplete vaccine stock data for calculating Wastage rates. Among facilities with sufficient data, mean monthly facility-level Wastage rates were between 18 and 35% across all reviewed vaccines, with little difference between lyophilized and liquid vaccines. Most (98%) vaccinators believed high Wastage led to recent vaccine stockouts, yet only 55% were familiar with the multi-dose vial policy for minimizing Wastage. On average, vaccinators reported that a minimum of six children must be present prior to opening a 10-dose MCV vial. Third dose of diphtheria-tetanus-pertussis vaccine (DTP3) was administered in 84% of sessions and MCV in 63%; however, the number of MCV and DTP3 doses administered were similar indicating the number of children vaccinated with DTP3 and MCV were similar despite less frequent MCV vaccination opportunities. Among caregivers, 30% reported being turned away for vaccination at least once; 53% of these children had not yet received the missed dose. Discussion Our findings show inadequate implementation of vaccine management guidelines, missed opportunities to vaccinate, and lyophilized vaccine Wastage rates below expected rates. Missed opportunities for vaccination may occur due to how the health system’s contradicting policies may force health workers to prioritize reduced Wastage rates over vaccine administration, particularly for multi-dose vials.
Rajesh Guleri - One of the best experts on this subject based on the ideXlab platform.
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Documentation of vaccine Wastage in two different geographic contexts under the universal immunization program in India
BMC public health, 2020Co-Authors: Manoja Kumar Das, Mangla Sood, Muralidhar Parashuram Tambe, Thakur Dutt Sharma, Malangori A. Parande, Jitendra Bhaskar Surwade, Nandakumar Manikrao Salunkhe, Shital Somsing Patil, Bhagwan Pawar, Rajesh GuleriAbstract:Government of India is introducing new and relatively costly vaccines under immunization program. Monitoring of vaccine Wastage is needed to guide the program implementation and forecasting. Under pilot introduction of rotavirus vaccine in two districts both 5- and 10-doses vials were used, which was considered as an opportunity for documenting the Wastage. The Wastage rates for other routine vaccines were also documented. A survey conducted in two districts (Kangra, Himachal Pradesh and Pune, Maharashtra) covered 49 vaccine stores, 34 sub-centres and 34 outreach sessions collected vaccine receipt, distribution and usage data for two complete years 2016 and 2017. The overall Wastage rates for almost all vaccines were higher in Kangra district (BCG 37.1%, DPT 32.1%, Measles 32.2%, OPV 50.8%, TT 34.1% and pentavalent 18.4%) than Pune district (BCG 35.1%, DPT 25.4%, Measles 21.7%, OPV 14.3%, TT 23.1% and pentavalent 13.2%). Wastage for pneumococcal conjugate and measles-rubella vaccines in Kangra district were 27 and 40.5%, respectively. With transition from 5- to 10-doses vials for rotavirus vaccine, Wastage at stores levels increased in both Kangra (29 to 33.2%) and Pune (17.8 to 25.7%) districts. With transition from intramuscular to intradermal fractional inactivated polio vaccine, the Wastage increased from 36.1 to 54.8% in Kangra and 18.4 to 26.9% in Pune district. The observed vaccine Wastage rates for several vaccines were relatively higher than program assumption for forecasting. The observed variations in the vaccine Wastage indicates need for state or region based documentation and monitoring in India for appropriate programmatic action.
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Documentation of vaccine Wastage in two different geographic contexts under the universal immunization program in India
BMC Public Health, 2020Co-Authors: Manoja Kumar Das, Mangla Sood, Muralidhar Parashuram Tambe, Thakur Dutt Sharma, Malangori A. Parande, Jitendra Bhaskar Surwade, Nandakumar Manikrao Salunkhe, Shital Somsing Patil, Bhagwan Pawar, Rajesh GuleriAbstract:Background Government of India is introducing new and relatively costly vaccines under immunization program. Monitoring of vaccine Wastage is needed to guide the program implementation and forecasting. Under pilot introduction of rotavirus vaccine in two districts both 5- and 10-doses vials were used, which was considered as an opportunity for documenting the Wastage. The Wastage rates for other routine vaccines were also documented. Methods A survey conducted in two districts (Kangra, Himachal Pradesh and Pune, Maharashtra) covered 49 vaccine stores, 34 sub-centres and 34 outreach sessions collected vaccine receipt, distribution and usage data for two complete years 2016 and 2017. Results The overall Wastage rates for almost all vaccines were higher in Kangra district (BCG 37.1%, DPT 32.1%, Measles 32.2%, OPV 50.8%, TT 34.1% and pentavalent 18.4%) than Pune district (BCG 35.1%, DPT 25.4%, Measles 21.7%, OPV 14.3%, TT 23.1% and pentavalent 13.2%). Wastage for pneumococcal conjugate and measles-rubella vaccines in Kangra district were 27 and 40.5%, respectively. With transition from 5- to 10-doses vials for rotavirus vaccine, Wastage at stores levels increased in both Kangra (29 to 33.2%) and Pune (17.8 to 25.7%) districts. With transition from intramuscular to intradermal fractional inactivated polio vaccine, the Wastage increased from 36.1 to 54.8% in Kangra and 18.4 to 26.9% in Pune district. Conclusions The observed vaccine Wastage rates for several vaccines were relatively higher than program assumption for forecasting. The observed variations in the vaccine Wastage indicates need for state or region based documentation and monitoring in India for appropriate programmatic action.
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Documentation of vaccine Wastage in two different geographic contexts under the universal immunization program in India
2019Co-Authors: Manoja Kumar Das, Mangla Sood, Thakur Dutt Sharma, Malangori A. Parande, Jitendra Bhaskar Surwade, Shital Somsing Patil, Bhagwan Pawar, Muralidhar Tambe, N M Salunke, Rajesh GuleriAbstract:Abstract Background Government of India is introducing new and relatively costly vaccines under immunization program. Monitoring of vaccine Wastage is needed to guide the program implementation and forecasting. Under pilot introduction of rotavirus vaccine in two districts both 5- and 10-doses vials were used, which was considered as an opportunity for documenting the Wastage.Methods A survey conducted in two districts (Kangra, Himachal Pradesh and Pune, Maharashtra) covered 49 vaccine stores, 34 sub-centres and 34 outreach sessions collected vaccine receipt, distribution and usage data for two complete years 2016 and 2017.Results The overall Wastage rates for almost all vaccines were higher in Kangra district (BCG 37.1%, DPT 32.1%, Measles 32.2%, OPV 50.8%, TT 34.1% and pentavalent 18.4%) than Pune district (BCG 35.1%, DPT 25.4%, Measles 21.7%, OPV 14.3%, TT 23.1% and pentavalent 13.2%). Wastage for pneumococcal conjugate and measles-rubella vaccines were 27% and 40.5%, respectively. With transition from 5- to 10-doses vials for rotavirus vaccine, Wastage at stores levels increased in both Kangra (29% to 33.2%) and Pune (17.8% to 25.7%) districts. With transition from intramuscular to intradermal fractional inactivated polio vaccine, the Wastage increased from 36.1% to 54.8% in Kangra and 18.4% to 26.9% in Pune district.Conclusions The observed vaccine Wastage rates were relatively higher than program assumption for forecasting. The observed variations in the vaccine Wastage indicates need for state or region based documentation and monitoring in India for appropriate programmatic action.
Adam Friebe - One of the best experts on this subject based on the ideXlab platform.
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red cell inventory management and red cell Wastage reduction strategies in a major regional laboratory
Pathology, 2015Co-Authors: Song Chen, Geoff Davey, Linda Saravanan, Helen Fairweather, Adam FriebeAbstract:Aims Red cell inventory management is important for quality control in transfusion medicine. In remote areas, to achieve a good blood product inventory management is even more challenging due to geographical impact on availability of blood products. The aim of this project is to significantly reduce red cell Wastage rates at St John of God Pathology (SJOG), Geelong, Victoria, Australia. Methods Data from the BloodNet for a 12-month period (11/2012–10/2013) regarding the red cell inventory performance status (with focus on red cell Wastage rate) at the local laboratory, statewide and a national level was reviewed. Issues of high red cell Wastage rates were identified and strategies of red cell Wastage reduction were initiated to improve red cell inventory management. Result Data of red cell Wastage rates from 04/2014 to 10/2014 from the BloodNet showed a significant reduction (from 10–20% to 5%) on red cell Wastage rates at SJOG Pathology, Geelong. This has met our primary goal of this project. Discussion This project demonstrates a good outcome on red cell inventory management in a major regional laboratory using daily estimation method with a good contingency plan. The BloodNet is a useful tool to manage red cell inventory.
