OBJECTIVES: The targeted literature review (TLR) aimed to evaluate vaccine preparation time, associated labor costs and preference of healthcare practitioners for vaccines that require reconstitution (VRR) vs vaccines that are supplied as a pre-filled syringe (PFS).

METHODS: A TLR was conducted in Embase and MEDLINE to identify studies that measured time or costs associated with the two vaccine formulations. We supplemented the list by searching the references and citations referenced by included studies. Eligibility criteria were developed based on formulation and outcomes. Costs in USD dollars were extracted.

RESULTS: Of 344 studies screened, 9 were eligible, including 2 time and motion, 2 with labor costs, 1 interview-based assessment of time and cost, and 8 with preference data. From 3 studies, time associated with vaccine administration averaged 30, 33 and 36 seconds for PFS and 66, 70.5 and 75 seconds for VRR. Considering median pharmacist pay of $61.8/hr the labor cost for administering PFS is $0.62/dose and $1.29 for administering VRR. Assuming similar annual vaccination rate for flu of 69.8% this translates into $26.1 million projected labor cost savings for PFS vaccines. Similar administration costs were reported in other countries, with a mean cost/dose for PFS of $0.82 and $1.64 for VRR in Belgium, and $3.56 and $6.23, respectively, in Malaysia. Studies that reported preference found that PFS was the preferred formulation, with main reasons being ease of administration and reduced immunization errors (number of VRR errors was 47 vs. 10 for PFS; out of total 57 immunization errors in 192 preparations).

CONCLUSIONS: Compared with VRR, PFS vaccines require roughly half the time for administration, half the mean cost in labor and are associated with a reduced number of errors. Vaccine programs that select PFS formulations might have the potential for significant savings due to reduced labor and error-related costs.