UNIVAC decision support model

A universal framework for evaluating vaccine policy options in low- and middle-income countries

Key questions

1. How do you access, navigate and run UNIVAC?

2. How are the UNIVAC inputs used to generate outputs?

Key questions

Main output (outcome measure)

1. Cost-utility ratio Cost per DALY averted

What is a DALY?

• Should we choose option 1 or 2?

– Option 1 (HPV vaccine) – prevents 250 deaths

– Option 2 (PCV vaccine) – prevents 200 deaths

• Choosing option 1 might not be fair

– Cervical cancer deaths mostly occur in adults

– Pneumococcal deaths mostly occur in children

• It would be fairer to compare the number of prevented YLLs (Years of Life Lost)?

– Option 1 (HPV vaccine) – prevents 12,500 YLLs

– Option 2 (PCV vaccine) – prevents 20,000 YLLs

• It would be fairer to compare the number of prevented YLLs (Years of Life Lost)?

– Option 1 (HPV vaccine) – prevents 12,500 YLLs

– Option 2 (PCV vaccine) – prevents 20,000 YLLs

,1020,000 YLLs prevented is the same as 20,000 Years of Life gained

…but this still isn’t a fair comparison

• …because it doesn’t take into account prevented YLDs (Years of Life lost due to living with the Disease)

• YLDs take into account:

– The number of disease cases

– Years lived with the disease eg. 0.5 years

– % of diseased time lost eg. 35% (disability weight)

• It would be fairer to use DALYs (YLLs + YLDs)

– Option 1 (HPV vaccine) – prevents 22,000 DALYs

– Option 2 (PCV vaccine) – prevents 28,000 DALYs

• …because it doesn’t take into account prevented YLDs (Years of Life lost due to living with the Disease)

• YLDs take into account:

– The number of disease cases

– Years lived with the disease eg. 0.5 years

– % of diseased time lost eg. 35% (disability weight)

• It would be fairer to use DALYs (YLLs + YLDs)

– Option 1 (HPV vaccine) – prevents 22,000 DALYs

– Option 2 (PCV vaccine) – prevents 28,000 DALYs

,1328,000 DALYs prevented is the same as 28,000 QALYs gained

Outputs of UNIVAC

1. Cost-utility ratio Cost per DALY averted

2. Vaccine costs Incremental vaccine costs

3. Healthcare costs Healthcare costs averted

4. Disease events Cases, visits, hosps., deaths, DALYs

5. Adverse events Cases, visits, hosps., deaths, DALYs

6. Benefit-risk ratio e.g. Deaths averted per death caused

Without vaccination, how many disease events can we expect over the lifetime of a birth cohort?

• Start by using United Nations Population Division (UNPOP) projections of the number of individuals that will be alive in each single year of age (and single calendar year) as the birth cohort ages…

SCALENDAR YEARS

2013 1000 950 920 910 900 895 890 885 880 875 870 865 860 855 850 845 840 835

SCALENDAR YEARSPopulation, no vaccine

0 1 2 3 4

Years of age

5 6 7 8 9 etc……………………….......

• Multiply by age-specific rates of disease per 100,000 per year to estimate numbers of disease events…

2013 50 40 20 10 5 0 0 0 0 0 0 0 0 0 0 0 0 0

SCALENDAR YEARSDeaths, no vaccine

0 1 2 3 4

Years of age

5 6 7 8 9 etc……………………….......

2013 50 40 20 10 5 0 0 0 0 0 0 0 0 0 0 0 0 0

0 1 2 3 4

Years of age

For simplicity, this

example focuses on

disease in under-fives

2013 50 40 20 10 5

0 1 2 3 4

Years of age

• If you want to account for changes in inputs over time (e.g. demography, mortality rates, coverage, price) then repeat for up to 30 birth cohorts…

2013 50 40 20 10 5

0 1 2 3 4

Years of age

2013 50 40 20 10 5

2014 50 40 20 10 5

2013 50 40 20 10 5

2014 50 40 20 10 5

2015 50 40 20 10 5

2013 50 40 20 10 5

2014 50 40 20 10 5

2015 50 40 20 10 5

2016 50 40 20 10 5

2013 50 40 20 10 5

2014 50 40 20 10 5

2015 50 40 20 10 5

2016 50 40 20 10 5

2017 50 40 20 10 5

2013 50 40 20 10 5

2014 50 40 20 10 5

2015 50 40 20 10 5

2016 50 40 20 10 5

2017 50 40 20 10 5

2018 50 40 20 10 5

2019 50 40 20 10 5

2020 50 40 20 10 5

2021 50 40 20 10 5

2022 50 40 20 10 5

2023 50 40 20 10 5

2024 50 40 20 10 5

2025 50 40 20 10 5

2026 50 40 20 10 5

2013 50 40 20 10 5

2014 50 40 20 10 5

2015 50 40 20 10 5

2016 50 40 20 10 5

2017 50 40 20 10 5

2018 50 40 20 10 5

2019 50 40 20 10 5

2020 50 40 20 10 5

2021 50 40 20 10 5

2022 50 40 20 10 5

2023 50 40 20 10 5

2024 50 40 20 10 5

2025 50 40 20 10 5

2026 50 40 20 10 5

Also useful if you want to report

results by ‘calendar year’

• If you want to account for changes in inputs over time (e.g. demography, mortality rates, coverage, price) then repeat for up to 30 birth cohorts…

• Repeat for each disease type and outcome…

Disease

type 1

VisitsCases Hosps. Deaths

Disease

type 1

Disease

type 2

Disease

type 1

Disease

type 2

Disease

type 3

…up to

10 types

Any RVGE

Example: Rotavirus configuration 1

Any RVGE

Any GE

Non-severe

Severe

Non-severe

Severe

Intussusception

• The background rate of severe adverse

events can also be included if required.

• Users can then enter the relative risk of

vaccination compared to this background

rate to estimate vaccine-related events.

Non-severe

Severe

Intussusception

• Start by specifying the period of vaccination…

With vaccination, how many disease events can we expect over the lifetime of a birth cohort?

2013 50 40 20 10 5

2014 50 40 20 10 5

2015 50 40 20 10 5

2016 50 40 20 10 5

2017 50 40 20 10 5

2018 50 40 20 10 5

2019 50 40 20 10 5

2020 50 40 20 10 5

2021 50 40 20 10 5

2022 50 40 20 10 5

2023 50 40 20 10 5

2024 50 40 20 10 5

2025 50 40 20 10 5

2026 50 40 20 10 5

Vaccinate

infants born

2017-2026…

• Multiply age-specific disease events by:

1 – [ (% covered by only 1 dose x efficacy of dose 1)

+ (% covered by only 2 doses x efficacy of dose 2)

….etc. ]

• Multiply age-specific disease events by:

1 – [ (% covered by only 1 dose x efficacy of dose 1)

….etc. ]

This calculation is applied by year of age 5-99 years and

by week of age <5 years. UNIVAC therefore asks for

additional inputs <5yrs:• Age distribution of disease by week of age <5yrs;

• Vaccine coverage/timeliness by week of age <5yrs;

• Vaccine efficacy by time in weeks since dose given.

2013 50 40 20 10 5

2014 50 40 20 10 5

2015 50 40 20 10 5

2016 50 40 20 10 5

2017 50 40 20 10 5

2018 50 40 20 10 5

2019 50 40 20 10 5

2020 50 40 20 10 5

2021 50 40 20 10 5

2022 50 40 20 10 5

2023 50 40 20 10 5

2024 50 40 20 10 5

2025 50 40 20 10 5

2026 50 40 20 10 5

Vaccinate

infants born

2017-2026…

2013 50 40 20 10 5

2014 50 40 20 10 5

2015 50 40 20 10 5

2016 50 40 20 10 5

2017 5 4 2 1 1

2018 5 4 2 1 1

2019 5 4 2 1 1

2020 5 4 2 1 1

2021 5 4 2 1 1

2022 5 4 2 1 1

2023 5 4 2 1 1

2024 5 4 2 1 1

2025 5 4 2 1 1

2026 5 4 2 1 1

SCALENDAR YEARSDeaths, routine vaccine

Vaccinate

infants born

2017-2026…

…and apply

age-specific

direct impact

e.g. ~50000 ‘future deaths’ prevented if all

children born 2017-2026 are tracked over their

lifetimes

COMPARATOR

50760 deaths

without vaccine

NEW OPTION

590 deaths

with vaccine

Advantages• Accessibility – developed in

Excel so familiar to most users;

• Transparency – can be easily explained to national teams and decision makers;

• Simplicity – uses a minimal set of inputs and steps;

• Flexibility – can be quickly adapted to evaluate new options in a timely way;

• Comparability – allows for more standardised comparisons between vaccine policy options;

Drawback• Static – unlike dynamic models,

UNIVAC does NOT track the number of susceptible, infectious and immune individuals over time, so cannot directly simulate herd (and other indirect) effects.

• However, in mitigation (!), calibration of dynamic models:

– can be a lengthy/complex process;

– may not provide estimates defensible by MoH if based on poor quality data;

– may not be necessary if plausible ‘what-if’ scenarios can demonstrate that inclusion of indirect effects would not change the recommendation/decision.

UNIVAC advantages and drawbacks

If you want to know more…

▪ The Provac Toolkit

https://www.paho.org/provac-toolkit/

▪ Partners

UNIVAC decision support model - paho.org

Documents

general description UNIVAC 1616

L T L - paho.org

RESPIRATORY - paho.org

RAND UNIVAC

Sperry Univac System 80

Resultados Final Univac 2012

no MHC Caldwell Vacuum Lifters Narrow Applications-1stlcrane.com/wp-content/...application_vacuum_lifters_brochure.pdfUNIVAC-250 UNIVAC-250 UNIVAC-250 UNIVAC-250 UNIVAC-250 UNIVAC-250

Univac/Uniscope 300, ca1960 - Computer History …s3data.computerhistory.org/brochures/univac.uniscope-300.ca1960...and a variety of other UNIVAC computer communication devices. Today,

Univac 9400 System, ca. 1969 - Computer History Museum

UNIVAC Mold Charts - Specialty Tooth Supplyspecialtytoothsupply.com/downloads/mold-charts-univac.pdfUNIVAC' AND UNIVAC POLYCHROME' PORCELAIN ANTERIORS C DOMINANTLY CURVED LABIALS All

Situation analysis - paho.org

The Univac 90 / 60 Mainframe Computer

Ambient Air Quality Monitoring - paho.org

Univac 9200 and 9300 Systems, 1967 - Archive Serverarchive.computerhistory.org/resources/text/Remington_Rand/Sperry...SPERRY RAND LJNIVAC" ... UNIVAC SERIES UNIVAC 9200 and 9300 Systems

The Univac Data Communications System, 1957archive.computerhistory.org/resources/text/Remington_Rand/Univac...a film strip on the Univac Data Communications System. ... your 1 ocal

UNIVAC CONFERENCE OH 200 - University of Minnesota

UNIVAC Minuteman Weapon System Computer Plated Wire

FOR UNIVAC 1107/1108 PROGRAMMERS GUIDE AND …

UNIVAC OPERATOR & PARTS MANUAL - Kaivac, Inc

UNIVAC FEDERAL SYSTEMS DIVISION Ul - Honeysuckle Creek