Primary Vaccine Container Roundtable: Modeling

Transcription

1 Primary Vaccine Container Roundtable: Modeling Bruce Y. Lee, MD, MBA Associate Professor of Medicine, Epidemiology, and Biomedical Informatics University of Pittsburgh

2 HERMES Vision Data on Supply Chain Structure, Storage Locations, Transport, Capacities, Personnel, etc. Standard input deck Create a freely available and userfriendly software tool for decision makers to generate an interactive simulation model of any supply chain (= a virtual laboratory). Supply chain function costs Economic Metrics Discrete event simulation model of supply chain Supply chain performan ce metrics OPTIMIZE supply chain costing tool Total Costs Unit Costs 2 Cost Drivers

3 HERMES Can Address Impact of introducing new technology e.g., vaccines, storage, and monitoring Characteristics of vaccines and other technologies e.g., vaccine vial size, vaccine thermostability, cold device capacity Configuration and operations of the supply chain e.g., storage, shipping frequency, personnel, ordering policy Effects of differing conditions/circumstances e.g., power outages, delays, inclement weather, limited access Investment or allocation of resources e.g., adding refrigerators vs. increasing transport frequency Optimizing vaccine delivery e.g., minimize cost, cost per outcome, maximize immunizations 3

4 * Discrete Event Simulation Model Each Storage Facility Refrigerator * * Next Level 1 Higher Level Transport Each vaccine vial = entity Each diluent vial = entity Refrigerator Refrigerator Freezer * * * * * * Capacity Temperature range Probability of failure or delay Next Level 2 Next Level 3 4

5 Health Service Delivery Location An example of the possible devices available at any location Refrigerator Higher Level Vaccine carrier Health care worker: 1. opens vaccine vial and reconstitutes with diluent (if required) 2. administers vaccine to client Client arrival based on health system or census/birth data If the correct vaccine is Available = successful immunization Not available = missed immunization opportunity Example of outputs Open vial wastage = unused doses in opened vials Medical Waste 5 vaccine availability = clients successfully immunized all clients arriving

6 What do you need to model a supply chain? Identify purpose of simulation Questions to address Perspective of user Determine detail of simulation model required Less detail to address general, simpler questions More detail to address more complex questions Gather and input supply chain data into HERMES Less data less detailed simulation model More data more detailed simulation model Decision maker can directly run HERMES on any laptop computer 6

7 Niger Supply Chain Serum Institute Sanofi Aventis Central Store Regional Store Regional Store Regional Store Regional Store Regional 1 Month Store Regional Store Regional Store 42 District Stores (Chest 1 Month Refrigerators and Freezers) 600+ Clinics (Small 600+ Refrigerators Clinics and/or Freezers)

8 Thailand Supply Chain International Manufacturers Domestic Manufacturers National Site (1 location) Trang Province Regional Site (1 location) Trang Provincial Site (1 location) District Health Offices (8) Intermediary (1) District Sites (21) Levels of vaccine administration Hospitals (9) Municipal Health Centers (3) Sub-district Sites (126) 8 Patients Patients

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10 Vaccine Availability Vaccine Availability (%) Vaccine Availability (%) Vaccine Availability (%) Vaccine Availability (%)

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12 Vaccine Availability

13 Vaccine Jul 19;28(32): Epub 2010 Jun 3. PMID: [PubMed indexed for MEDLINE

14 Cost per Dose by Arrival Rate

15 Optimal Vial Size

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17 Capacity Utilization Rates Ten-dose Measles vaccine Transport space utilization Regional to Provincial (1 route) Provincial to 30.9% District (range: 6.9%-105.5%) * District to Subdistrict (range: 22.9%-85.4%) 42.7% Storage space utilization Regional (1 site) Single-dose MMR vaccine * Only one transport device would need to utilize more than 100% of the available space ** Only two transport devices would need to utilize more than 100% of the available space Single-dose Measles vaccine 3.8% 4.3% 4.0% 37.6% (range: 8.7%-117.2%) ** 49.9% (range: 24.0%-106.9%) * 33.5% (range: 7.5%-111.1%) * 45.3% (range: 23.5%-97.5%) 28.2% 41.9% 35.0% Provincial (1 site) 29.2% 33.7% 31.0% District Sub-district 2.2% (range: 0.7%-4.5%) 0.9% (range: 0.4%-1.6%) % (range: 0.7% - 5.1%) 1.1% (range: 0.6%-2.4%) 2.6% (range: 0.7%-4.8%) 1.1% (range: 0.6%-2.3%)

18 Vaccine Availability Mean Min Max Ten-dose measles District 94.40% 90.80% 98.90% Sub-district 95.60% 86.20% % Single-dose MMR District 92.40% 88.20% 98.70% Sub-district 83.40% 72.70% 92.90% Single-dose measles District 91.90% 87.90% 98.50% Sub-district 83.60% 73.40% 91.70% 18

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20 Truck Capacity Utilization 10-dose measles vaccine vial size 5-dose measles vaccine vial size 2-dose measles vaccine vial size 1-dose measles vaccine vial size

21 Storage Capacity Utilization 10-dose measles vaccine vial size 5-dose measles vaccine vial size 2-dose measles vaccine vial size 1-dose measles vaccine vial size

22 Vaccine Availability Percentages Measles Vaccine Vial Size Scenario 10 doses per vial 5 doses per vial 2 doses per vial 1 doses per vial 100% Target Population Size Bacille-Calmette-Guerin Tuberculosis (BCG) 79% 79% 78% 76% Diptheria-tetanus-pertussis-hepatitis B- Haemophilus influenza type B 84% 84% 82% 80% (DTP-HepB-Hib) Measles 90% 87% 86% 80% Oral polio (OPV) 80% 80% 78% 76% Tetanus toxoid (TT) 84% 84% 83% 80% Yellow fever (YF) 79% 79% 78% 76% 80% Target Population Size BCG 84% 85% 85% 84% DTP-HepB-Hib 86% 86% 86% 84% Measles 94% 92% 89% 84% OPV 80% 80% 80% 79% TT 86% 86% 86% 84% YF 84% 85% 85% 84% 60% Target Population Size BCG 81% 81% 81% 80% DTP-HepB-Hib 91% 91% 91% 89% Measles 93% 91% 91% 90% OPV 82% 82% 82% 82% TT 90% 90% 90% 89% YF 81% 81% 81% 80%

23 Summary and Discussion HERMES can rapidly create a simulation model of any supply chain Serve as a virtual laboratory to help a wide variety of vaccine decision makers answer any number of questions EVM+HERMES: World Health Organization (WHO), UNICEF, Bill and Melinda Gates Foundation 23

24 Vaccine Logistics Team Tina-Marie Assi, PhD Epidemiology Leila A. Haidari, BS Epidemiology Michelle M. Schmitz, BA Computational Modeling Shawn T. Brown, PhD Computational Science Bruce Y. Lee, MD, MBA Epidemiology, Economics, and Operations Research Rachel B. Slayton, PhD Epidemiology Donald S. Burke, MD Infectious Diseases, Jim Leonard Computer Science Angela R. Wateska, MPH Epidemiology Brigid E. Cakouros, BA Behavioral and Community Health Sciences Leslie E. Mueller, BS Epidemiology Joel S. Welling, PhD Computer Science Sheng-I Chen, MS Industrial Engineering Bryan A. Norman, PhD Industrial Engineering Yu-Ting Weng, MS Biostatistics Erin G. Claypool, PhD Industrial Engineering Jayant Rajgopal, PhD Industrial Engineering Carol Levin, PhD PATH, Optimize Diana L. Connor, MPH Infectious Diseases and Microbiology Proma Paul, MPH Epidemiology Mercy Mvundura, PhD PATH, Optimize May 29, Bill & Melinda Gates Foundation 2

25 Contact Information Bruce Y. Lee, MD MBA Associate Professor of Medicine, Epidemiology, and Biomedical Informatics University of Pittsburgh 200 Meyran Avenue, Suite 200 Pittsburgh, PA