Informing pediatric vaccine procurement policy via the pediatric formulary design, pricing, and production problem

ABSTRACT This research improves upon the monopsonist vaccine formulary design problem in the literature by incorporating several modeling enhancements and applying different methodologies to efficiently obtain solutions and derive insights. Our multi-objective formulation seeks to minimize the overall price to immunize a cohort of children, maximize the net profit shared among pediatric vaccine manufacturers, and minimize the average number of injections per child among the prescribed formularies. Accounting for Centers for Disease Control and Prevention (CDC) guidelines, we restrict vaccines utilized against a given disease within a given formulary to those produced by a single manufacturer. We also account for a circumstance in which one manufacturer's vaccine has a greater relative efficacy. For the resulting nonconvex mixed-integer nonlinear program, we bound the second and third objectives using optimal formulary designs for current public sector prices and utilize the ϵ -constraint method to solve an instance representative of contemporary immunization schedule requirements. Augmenting our formulation with symmetry reduction constraints to reduce the required computational effort, we identify a set of non-inferior solutions. Of practical interest to the CDC, our model enables the design of a pricing and purchasing policy, creating a sustainable and stable capital investment environment for the provision of pediatric vaccines.