Presentation (CTI)

OBJECTIVES: Formulation-specific cold-chain requirements are not commonly incorporated into vaccine economic evaluations, yet they may materially influence product choice, budget impact, and implementation feasibility in public immunization programs. We compared the supply-chain costs of ultra-low-temperature (ULT) versus refrigeration stable (RS) COVID-19 vaccine formulations in Brazil from a public-sector health system perspective, focusing on deployment efficiency and wastage.
METHODS: A deterministic supply-chain cost model was developed to estimate operational costs for a hypothetical vaccination program delivering 1,000,000 doses in Brazil. Cost categories included airport receiving, central storage capital expenditure, distribution, local storage, administration-related wastage, energy consumption, and carbon emissions. Model inputs were drawn from public cost sources, published literature, and Brazil-relevant operational assumptions informed by formulation-specific handling requirements. Cost inputs for storage, distribution, equipment, and energy were based on published and market-derived estimates, while wastage assumptions were informed by evidence on handling complexity and operational experience reported in the literature.
RESULTS: Total annual supply-chain costs were estimated at US$5,960,648 for ULT formulations and US$1,936,746 for RS formulations, with ULT costs approximately 3.1-fold higher and an incremental difference of US$4,023,901. Administration-related wastage was the primary cost driver in both scenarios, accounting for US$4,800,000 in the ULT scenario and US$1,600,000 in the RS scenario. Additional cost components favoring RS formulations included local storage, distribution, and central storage capital costs.
CONCLUSIONS: RS COVID-19 vaccine formulations were associated with substantially lower supply-chain costs than ULT formulations. Formulation-specific deployment requirements, although infrequently captured in vaccine economic evaluations, may materially affect procurement decisions, implementation feasibility, and budget impact in public immunization programs. Incorporating operational costs alongside acquisition price may support more efficient vaccine selection, particularly in settings with constrained cold-chain capacity.