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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
1. How do you access, navigate and run UNIVAC?
2. How are the UNIVAC inputs used to generate outputs?
Key questions
1. How do you access, navigate and run UNIVAC?
2. How are the UNIVAC inputs used to generate outputs?
Main output (outcome measure)
1. Cost-utility ratio Cost per DALY averted
What is a DALY?
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• Should we choose option 1 or 2?
– Option 1 (HPV vaccine) – prevents 250 deaths
– Option 2 (PCV vaccine) – prevents 200 deaths
,7
• 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
,8
• 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
,9
• 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
,1020,000 YLLs prevented is the same as 20,000 Years of Life gained
…but this still isn’t a fair comparison
11
• …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
,12
• …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…
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2013
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2015
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BIR
TH
CO
HO
RT
SCALENDAR YEARS
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2013 1000 950 920 910 900 895 890 885 880 875 870 865 860 855 850 845 840 835
2014
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BIR
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SCALENDAR YEARSPopulation, no vaccine
0 1 2 3 4
Years of age
5 6 7 8 9 etc……………………….......
• 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…
• Multiply by age-specific rates of disease per 100,000 per year to estimate numbers of disease events…
Without vaccination, how many disease events can we expect over the lifetime of a birth cohort?
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2013 50 40 20 10 5 0 0 0 0 0 0 0 0 0 0 0 0 0
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BIR
TH
CO
HO
RT
SCALENDAR YEARSDeaths, no vaccine
0 1 2 3 4
Years of age
5 6 7 8 9 etc……………………….......
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2013 50 40 20 10 5 0 0 0 0 0 0 0 0 0 0 0 0 0
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BIR
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SCALENDAR YEARSDeaths, no vaccine
0 1 2 3 4
Years of age
For simplicity, this
example focuses on
disease in under-fives
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2013 50 40 20 10 5
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BIR
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RT
SCALENDAR YEARSDeaths, no vaccine
0 1 2 3 4
Years of age
• 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…
• Multiply by age-specific rates of disease per 100,000 per year to estimate numbers of disease events…
• 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…
Without vaccination, how many disease events can we expect over the lifetime of a birth cohort?
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2013 50 40 20 10 5
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BIR
TH
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HO
RT
SCALENDAR YEARSDeaths, no vaccine
0 1 2 3 4
Years of age
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2013 50 40 20 10 5
2014 50 40 20 10 5
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SCALENDAR YEARSDeaths, no vaccine
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2013 50 40 20 10 5
2014 50 40 20 10 5
2015 50 40 20 10 5
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BIR
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SCALENDAR YEARSDeaths, no vaccine
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2014 50 40 20 10 5
2015 50 40 20 10 5
2016 50 40 20 10 5
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SCALENDAR YEARSDeaths, no vaccine
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2014 50 40 20 10 5
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SCALENDAR YEARSDeaths, no vaccine
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2014 50 40 20 10 5
2015 50 40 20 10 5
2016 50 40 20 10 5
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2018 50 40 20 10 5
2019 50 40 20 10 5
2020 50 40 20 10 5
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SCALENDAR YEARSDeaths, no vaccine
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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
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SCALENDAR YEARSDeaths, no vaccine
BIR
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S
Also useful if you want to report
results by ‘calendar year’
• 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…
• Multiply by age-specific rates of disease per 100,000 per year to estimate numbers of disease events…
• 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…
Without vaccination, how many disease events can we expect over the lifetime of a birth cohort?
Disease
type 1
VisitsCases Hosps. Deaths
Disease
type 1
Disease
type 2
VisitsCases Hosps. Deaths
VisitsCases Hosps. Deaths
Disease
type 1
Disease
type 2
Disease
type 3
…up to
10 types
Any RVGE
VisitsCases Hosps. Deaths
Example: Rotavirus configuration 1
Any RVGE
VisitsCases Hosps. Deaths
Example: Rotavirus configuration 2
Any GE
VisitsCases Hosps. Deaths
Example: Rotavirus configuration 3
Non-severe
RVGE
Severe
RVGE
VisitsCases Hosps. Deaths
Example: Rotavirus configuration 4
Non-severe
RVGE
Severe
RVGE
Intussusception
VisitsCases Hosps. Deaths
Example: Rotavirus configuration 5
• 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
RVGE
Severe
RVGE
Intussusception
VisitsCases Hosps. Deaths
Example: Rotavirus configuration 5
• Start by specifying the period of vaccination…
With vaccination, how many disease events can we expect over the lifetime of a birth cohort?
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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
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2024 50 40 20 10 5
2025 50 40 20 10 5
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BIR
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SCALENDAR YEARSDeaths, no vaccine
Vaccinate
infants born
2017-2026…
• Start by specifying the period of vaccination…
• 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)
+ (% covered by only 3 doses x efficacy of dose 3)
….etc. ]
With vaccination, how many disease events can we expect over the lifetime of a birth cohort?
• Start by specifying the period of vaccination…
• 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)
+ (% covered by only 3 doses x efficacy of dose 3)
….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.
With vaccination, how many disease events can we expect over the lifetime of a birth cohort?
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2016 50 40 20 10 5
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2019 50 40 20 10 5
2020 50 40 20 10 5
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2024 50 40 20 10 5
2025 50 40 20 10 5
2026 50 40 20 10 5
BIR
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RT
SCALENDAR YEARSDeaths, no vaccine
Vaccinate
infants born
2017-2026…
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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
BIR
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RT
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
