Maximizing the effectiveness of a pediatric vaccine formulary while prohibiting extraimmunization

The growing complexity of the United States Recommended Childhood Immunization Schedule has resulted in as many as five required injections during a single well-baby office visit. To reduce this number, vaccine manufacturers have developed combination vaccines that immunize against several diseases...

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Vydáno v:Health care management science Ročník 11; číslo 4; s. 339 - 352
Hlavní autoři: Hall, Shane N., Sewell, Edward C., Jacobson, Sheldon H.
Médium: Journal Article
Jazyk:angličtina
Vydáno: Boston Springer US 01.12.2008
Springer
Springer Nature B.V
Edice:Health Care Management Science
Témata:
Algorithms
Antigens
Approximation
Business and Management
Child
Childhood
Cost estimates
Diphtheria
Discrete optimization
Dynamic programming
Econometrics
Health Administration
Health Informatics
Hepatitis B
Heuristic
Heuristics
Humans
Immune system
Immunization
Immunization Schedule
Integer programming
Management
Manufacturers
Monte Carlo simulation
Operations research
Operations Research/Decision Theory
Optimization
Parents & parenting
Pediatric immunization
Pediatric vaccines
Pediatrics
Pilot projects
Poliomyelitis
Public health
Randomized algorithms
Randomized approximation algorithms
Schedules
Studies
Terminology
Tetanus
Vaccination - statistics & numerical data
Vaccines
Vaccines - administration & dosage
Whooping cough
Integer programming
Randomized approximation algorithms
Heuristics
Pediatric immunization
Discrete optimization
Pediatric vaccines
Dynamic programming
ISSN:1386-9620, 1572-9389
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Shrnutí:The growing complexity of the United States Recommended Childhood Immunization Schedule has resulted in as many as five required injections during a single well-baby office visit. To reduce this number, vaccine manufacturers have developed combination vaccines that immunize against several diseases in a single injection. At the same time, a growing number of parents are challenging the safety and effectiveness of vaccinating children. They are also particularly concerned about the use of combination vaccines, since they believe that injecting a child with multiple antigens simultaneously may overwhelm a child’s immune system. Moreover, combination vaccines make it more likely that extraimmunization (i.e., administering more than the required amount of vaccine antigens) occurs, resulting in greater concerns by parents and vaccine wastage costs borne by an already strained healthcare system. This paper formulates an integer programming model that solves for the maximum number of vaccines that can be administered without any extraimmunization. An exact dynamic programming algorithm and a randomized heuristic for the integer programming model is formulated and the heuristic is shown to be a randomized ξ-approximation algorithm. Computational results are reported on three sets of test problems, based on existing and future childhood immunization schedules, to demonstrate their computational effectiveness and limitations. Given that future childhood immunization schedules may need to be solved for each child, on a case-by-case basis, the results reported here may provide a practical and valuable tool for the public health community.
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ISSN:1386-9620
1572-9389
DOI:10.1007/s10729-008-9068-5