Vaccine Presentation in the USA: Economics of Prefilled Syringes versus Multidose Vials for Influenza Vaccination

Claudia C Pereira; David Bishai


Expert Rev Vaccines. 2010;9(11):1343-1349. 

In This Article

Abstract and Introduction


In the USA, influenza vaccines are available as parenteral injections or as an intranasal preparation. Injectable influenza vaccines are available in either multidose vial (MDV), single-dose vial or prefilled syringe (PFS) presentations. PFSs have gained market share in the USA but have not yet reached the levels of uptake currently seen in Western Europe. Here, we review the topic of vaccine presentation in the USA, with a special focus on influenza vaccines. Second, we present the results of a time-motion study that measured administration costs of influenza vaccination comparing MDVs versus PFSs during the 2009/2010 influenza campaign. Vaccinating with MDVs took an average 37.3 s longer than PFSs. The cost of administering 1000 immunizations in 2009 using MDVs were US$8596 versus US$8920.21 using PFSs. In a pandemic situation where 300 million Americans would require vaccination, PFSs would save 3.12 million h in healthcare worker time, worth US$111.1 million. The higher acquisition costs of PFS vaccines compared with MDVs are offset by lower administrative costs and increased safety.


Injectable influenza vaccination (this article focuses only on injectables; intranasal influenza vaccine [Flu-mist™] has an important role in influenza vaccination but is not considered here) in the USA is currently distributed in three main presentations: vials, which can be single or multidose (MDV), and prefilled syringes (PFSs). The USA predominantly uses MDVs, but PFSs have gained market share over the last few years.[101] We estimate that, currently, PFSs hold approximately 30% of the market for influenza vaccines. Comparing the two influenza vaccine preparations in terms of monetary acquisition, PFSs may cost slightly more per dose than MDVs, but could offer advantages in speed, disposal, wastage and patient safety owing to premeasured accurate doses that reduce dosing errors.[1–3] PFSs also reduce the risk of microbial contamination, which can occur from improper aseptic techniques. Vaccines in PFSs do not contain the preservative thimerosal, whereas MDV vaccines do. A drawback of PFSs is a requirement for more storage space as they can be heavily packaged by the manufacturer to prevent damage. Bulkier packaging can increase refrigeration costs. Production, shipment and storage of MDVs are all cheaper, but using MDVs can be more time consuming for the healthcare worker, because each dose must be drawn from the vial using a needle and an empty syringe, leading to higher administration costs. Using MDVs adds operational complexity and more potential for dosing errors and contamination.

The goal of this article is twofold. First, we provide a descriptive overview of the current literature on operational features of MDVs and PFSs. Second, we report measurements comparing the efficiency and costs associated with MDVs and PFSs for influenza vaccination during the 2009/2010 influenza campaign. Our measurements emerge from a time-motion study of the influenza vaccination process at immunization clinics. Nurses' activities related to MDVs and PFSs were observed and timed using a stop watch. All relevant usage costs associated with PFSs and MDVs were identified and compared. We also measured the amount of vaccine that remained in vials after they were deemed empty by the healthcare worker.


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