title: Estimated costs attributable to events of "out-of-temperature" in the stockpiling of hexavalent vaccines occurring in Italy.
abstract: BACKGROUND
  Antigens contained in vaccines are inherently unstable biologically; such a characteristic is conferred by their three-dimensional structure. Preserving the ability of the vaccines to protect against disease is necessary to ensure the supervision and monitoring of all steps of the cold chain. DTPa-HBV-IPV/Hib vaccine (Infanrix hexaTM, GSK Vaccines, Belgium) is designed to prevent disease due to diphtheria, tetanus, pertussis (DTP), hepatitis B virus (HBV), poliomyelitis and Haemophilus influenzae type b (Hib); it was first licensed for use in Europe in 2000 and is currently licensed in at least 95 countries. Since October 2013, more than 102 million doses of GSK's DTPa-HBV-IPV/Hib vaccine have been distributed globally, with nearly 15 million doses distributed in Italy. DTPa-HBV-IPV/Hib components are stable up to a temperature of 25°C for 72 hours. Lacking of officially approved stability data may generate some concern in case of cold chain accidents.
  
  
  METHODS
  An analysis based on collected data was carried out to estimate potential costs attributable to events of "out-of-temperature" in the stockpiling of hexavalent vaccines occurring in Italy in 2014.
  
  
  RESULTS
  The analysis, based on real data, documented that the loss for the National Health Service (NHS) was in the range of 100,000 - 400,000 euros in one year. However, the amount of money that in principle could have been lost would have ranged between nearly half and one million euros/year.
  
  
  CONCLUSIONS
  A substantial loss of money was avoided thanks to the availability of officially approved stability data for GSK's DTPa-HBV-IPV/Hib vaccine.
authors.affiliation: Payers and Evidence Solutions Department, GSK Vaccines, Verona, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Silvestri
authors.affiliation: Vaccines Medical Department, GSK Vaccines, Verona, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Marchetti
mesh_terms: D000941:Antigens / Q000276:immunology; D003365:Costs and Cost Analysis; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000191:economics / Q000276:immunology / Q000600:supply & distribution*; D004355:Drug Stability; D004356:Drug Storage / Q000191:economics / Q000592:standards; D018073:Haemophilus Vaccines / Q000191:economics / Q000276:immunology / Q000600:supply & distribution*; D017325:Hepatitis B Vaccines / Q000191:economics / Q000276:immunology / Q000600:supply & distribution*; D006801:Humans; D007558:Italy; D011054:Poliovirus Vaccine, Inactivated / Q000191:economics / Q000276:immunology / Q000600:supply & distribution*; D012034:Refrigeration; D017778:Vaccines, Combined / Q000191:economics / Q000276:immunology / Q000600:supply & distribution
chemical_list: D000941:Antigens; D015721:Diphtheria-Tetanus-Pertussis Vaccine; D018073:Haemophilus Vaccines; D017325:Hepatitis B Vaccines; D011054:Poliovirus Vaccine, Inactivated; D017778:Vaccines, Combined; C541235:diphtheria-tetanus-acellular pertussis-inactivated poliovirus-Haemophilus influenzae b conjugate-hepatitis B vaccine
keywords: Cold chain; Hexavalent; Stockpiling;; Vaccines