Economic comparison of cold chain storage and transportation assets

Dear Just to add to the benefits of such tool, it also helps understand the importance of calculating/estimating the vaccine needs. Some times we overestimate the needs and hence are putting extra burden on our cold chain capacity and expenditure. It is good to know how much is needed/cm3 volume in dollars. Best regards Dr. Faisal Mansoor Sr. Epidemiologist/Coordinator H1N1 Vaccine deployement NICP-Islamabad. Pakistan mobile +923335254085 office 0092519255780 fax 0092519255710 Residence 0092514415494

[indent]While doing the cost analysis, i would also look into following prospective ($/cm3/year does not take into consideration the population, which means it require the manager to go through the calculations of converting flow of vaccine into cm3 and then multiply with this factor to get the pulse of what is best for them). :  a. Cost per FIC of maintaining cold chain ; This include parameters of target population, immunization schedule, capital cost, operational cost, life of equipment and maintenance cost.  - With more number of vaccines in schedule, the cost per FIC of cold chain will reduce; - Higher the population of catchment area, lower the cold chain cost; - Longer the life of cold chain equipment, lower the CC cost;  - High energy efficient equipment, lower the CC cost.  Just an example, the compressor of Quality ILRs run longer initially to drop the temperature to the desire level and consumes more electricity but once it has reached the required temperature, because of excellent hold over time, compressor need to run for much less duration over a period of every 24 hrs as compared to domestic!  b. We need to come up with a matrix such that :  - With columns as of population band and immunization schedule ; - With rows classification as cold chain levels; - and refrigeration equipment as rows.  The cells of matrix shows the $ per FIC. These scenarios will help managers making the right decision. This will help in identifying which model works best at various levels given the population and immunization schedule and introduction of new vaccine.  Additionally , There is a classical debate of using or not using domestic refrigerators at the last cold chain points (PHC;s). PHCs are large in numbers, if you see whole country and need maximum investment to empower these units.  Wherein domestic refs, appears to be cheaper solution as it is locally available, costs within the range of 200-500$ maximum, easy to maintain, they do not offer the qualities of a standard cold chain equipment ; I would be eager to get such analysis result to support using (or not using) domestic refs as last cold chain point.  Ranjit Dhiman  [/indent]

Thank you for this challenging question on estimating supply chain requirements for new vaccines!  As far as I know there is no comprehensive tool to estimate, as you say: “ … [the] economic guidance to select the most adequate options based on each site and technology characteristics.”  There are however a number of tools that can provide some of the information that would be needed to make a cost estimate. The best overall descriptions can be found onhttp://www.who.int/immunization_delivery/systems_policy/logistics/en/index2.html (http://www.who.int/immunization_delivery/systems_policy/logistics/en/index2.html) where there is a table of contents as follows: Logistics support to immunization services (http://www.who.int/immunization_delivery/systems_policy/logistics/en/index.html) Vaccine management (http://www.who.int/immunization_delivery/systems_policy/logistics/en/index1.html) Vaccine forecast and needs estimation Vaccine stock management (http://www.who.int/immunization_delivery/systems_policy/logistics/en/index3.html) Vaccine volume calculator (http://www.who.int/immunization_delivery/systems_policy/logistics/en/index4.html) Cold chain and logisitics tools (http://www.who.int/immunization_delivery/systems_policy/logistics/en/index5.html)  All but one of these headings are hyperlinks to pages that give more details on each tool. There at least four more tools that might be useful: A recently completed Effective Vaccine Management assessment tool (EVM). This tool aims to combine the best of the former EVSM and VMA tools and eliminates the redundancies and incompatibilities between the two tools. The EVM is an assessment tool but it also provides the framework for management, monitoring, supervision, and improvement of the immunization supply chain system. More details can be found onhttp://technet21.org/forumV3/viewtopic.php?t=1446 (http://technet21.org/forumV3/viewtopic.php?t=1446). WHO-PATH Optimize is working on an excel-based costing approach that aims to estimate costs at each level. Although it currently aims to estimate cost per dose, the tool could be converted to provide a cost per cm3. Data collection for this tool is however quite intensive. There are also several other modelling initiatives that are under development. These are described in the Optimize Newsletter from June 2010: http://www.who.int/immunization_delivery/systems_policy/Optimize-newsletter-June-2010.pdf (http://www.who.int/immunization_delivery/systems_policy/Optimize-newsletter-June-2010.pdf). A Cold Chain Equipment Manager (CCEM) is under development that estimates costs, both recurrent and capital, of “asset selection” for refrigerators. CCEM will help facility-based “asset selection” by automating selection of equipment options based on user standardization preferences, among other characteristics. CCEM also models the impact of increased resupply intervals on refrigerator equipment needs (and costs.)  CCEM does not comprehensively model transport costs. It calculates total equipment costs and generates these as a unit per cm3. CCEM does not however provide a “detailed picture of the supply chain network economics by piecing together the situation of each node in the network.”  Even though we have not fully responded to your question, we hope this information will useful.  James Cheyne, with a lot of help from WHO (Geneva), UNICEF (New York) and PATH (Seattle).

Thanks for raising the issue of available tools for analyzing the cold chain and logistics. There are many aspects of this that are covered by different tools and models. Let me add to the comments that James gave on CCEM and give an update on the project.  CCEM (Cold Chain Equipment Manager) is an Access based program that we have been developing at PATH with support from USAID, UNICEF, and WHO. CCEM is focused on providing a facility level evaluation of cold chain capacity requirements. The capacity (liter) requirements are calculated at +4°C and -20°C for each store or facility according to the vaccination schedule, wastage rates, and the size of the target population. The capacity requirement calculation can be made for the current year or for future years and can be evaluated against the existing equipment inventory. CCEM can model changes in cold chain equipment needs based on standardization preferences, removal schedules, and supply intervals. The program also has a reporting functionality, including an analysis of running cost and capital.  We will be releasing a new version of the software, CCEM 2.1, in September 2010. The software will be available for download from www.path.org and will also be available on CD. We look forward to receiving feedback on the new version.  If you have questions, please contact us.  Richard Anderson ([[email protected]][email protected][/email] (https://pathmail.path.org/owa/redir.aspx?C=2a2689dc0fbd45b9a7e742e8ac5ed792&URL=mailto%3aranderson%40path.org)), Sophie Newland ([[email protected]][email protected][/email] (https://pathmail.path.org/owa/redir.aspx?C=2a2689dc0fbd45b9a7e742e8ac5ed792&URL=mailto%3asnewland%40path.org) ).