title: The budget impact of controlling wastage with smaller vials: A data driven model of session sizes in Bangladesh, India (Uttar Pradesh),Mozambique, and Uganda.
abstract: BACKGROUND
  Open vial vaccine wastage in multi-dose vials is a major contributor to vaccine wastage. Although switching from 10-dose vials to 5-dose vials could reduce wastage, a higher total cost could be triggered because smaller vials cost more to purchase and store.
  
  
  METHODS
  This study drew field data of daily session sizes in local vaccination facilities from Bangladesh, India (Uttar Pradesh), Mozambique, and Uganda, and used Akaike Information Criteria to determine the best fit statistical distribution across various clinic types. These distributions were input to estimate the vaccine wastage using Lee's (2010) model. Inactivated polio vaccine (IPV) immunization was simulated to compare the costs over ten years with 10-dose vials versus 5-dose vials.
  
  
  RESULTS
  By switching from 10- to 5-dose vials, the observed open vial wastage rate due to vial size preference and session size for IPV was reduced from 0.25 to 0.11 in Bangladesh, 0.17 to 0.08 in India (Uttar Pradesh), 0.13 to 0.06 in Mozambique, and 0.09 to 0.04 in Uganda, respectively. The cost savings realized from lower IPV wastage did not offset the higher costs of procurement and storage costs associated with smaller dose presentation.
  
  
  CONCLUSIONS
  While our model showed that switching from 10-dose vials to 5-dose vials of IPV reduced open vial wastage, it was not cost-saving.
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. Wanfei_yang@bd.com
authors.forename: Wanfei
authors.initials: W
authors.lastname: Yang
authors.forename: Monika
authors.initials: M
authors.lastname: Parisi
authors.forename: Betsy J
authors.initials: BJ
authors.lastname: Lahue
authors.forename: Md  Jasim
authors.initials: M
authors.lastname: Uddin
authors.forename: David
authors.initials: D
authors.lastname: Bishai
mesh_terms: D000293:Adolescent; D000349:Africa; D001208:Asia; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D004339:Drug Compounding / Q000191:economics* / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015233:Models, Statistical; D014611:Vaccination / Q000191:economics* / Q000379:methods*