A markov decision process model for the optimal dispatch of military medical evacuation assets.

We develop a Markov decision process (MDP) model to examine aerial military medical evacuation (MEDEVAC) dispatch policies in a combat environment. The problem of deciding which aeromedical asset to dispatch to each service request is complicated by the threat conditions at the service locations and the priority class of each casualty event. We assume requests for MEDEVAC support arrive sequentially, with the location and the priority of each casualty known upon initiation of the request. The United States military uses a 9-line MEDEVAC request system to classify casualties as being one of three priority levels: urgent, priority, and routine. Multiple casualties can be present at a single casualty event, with the highest priority casualty determining the priority level for the casualty event. Moreover, an armed escort may be required depending on the threat level indicated by the 9-line MEDEVAC request. The proposed MDP model indicates how to optimally dispatch MEDEVAC helicopters to casualty events in order to maximize steady-state system utility. The utility gained from servicing a specific request depends on the number of casualties, the priority class for each of the casualties, and the locations of both the servicing ambulatory helicopter and casualty event. Instances of the dispatching problem are solved using a relative value iteration dynamic programming algorithm. Computational examples are used to investigate optimal dispatch policies under different threat situations and armed escort delays; the examples are based on combat scenarios in which United States Army MEDEVAC units support ground operations in Afghanistan.

Analytics for vaccine economics and pricing: insights and observations.

Pediatric immunization programs in the USA are a successful and cost-effective public health endeavor, profoundly reducing mortalities caused by infectious diseases. Two important issues relate to the success of the immunization programs, the selection of cost-effective vaccines and the appropriate pricing of vaccines. The recommended childhood immunization schedule, published annually by the CDC, continues to expand with respect to the number of injections required and the number of vaccines available for selection. The advent of new vaccines to meet the growing requirements of the schedule results: in a large, combinatorial number of possible vaccine formularies. The expansion of the schedule and the increase in the number of available vaccines constitutes a challenge for state health departments, large city immunization programs, private practices and other vaccine purchasers, as a cost-effective vaccine formulary must be selected from an increasingly large set of possible vaccine combinations to satisfy the schedule. The pediatric vaccine industry consists of a relatively small number of pharmaceutical firms engaged in the research, development, manufacture and distribution of pediatric vaccines. The number of vaccine manufacturers has dramatically decreased in the past few decades for a myriad of reasons, most notably due to low profitability. The contraction of the industry negatively impacts the reliable provision of pediatric vaccines. The determination of appropriate vaccine prices is an important issue and influences a vaccine manufacturer's decision to remain in the market. Operations research is a discipline that applies advanced analytical methods to improve decision making; analytics is the application of operations research to a particular problem using pertinent data to provide a practical result. Analytics provides a mechanism to resolve the challenges facing stakeholders in the vaccine development and delivery system, in particular, the selection of cost-effective vaccines and the appropriate pricing of vaccines. A review of applicable analytics papers is provided.

Pricing strategies for combination pediatric vaccines and their impact on revenue: Pediarix or Pentacel?

This paper analyzes pricing strategies for pediatric combination vaccines and their impact on the United States pediatric vaccine market. Three pharmaceutical companies compete pairwise with each other over the sale of vaccines containing two or three antigens per injection. Specific emphasis is placed on examining the competition between two pentavalent vaccines: GlaxoSmithKline's Pediarix (DTaP-HepB-IPV) and Sanofi Pasteur's Pentacel (DTaP-IPV/Hib). The main contribution of the paper is to provide a methodology for analyzing pricing strategies of directly competing, partially overlapping, and mutually exclusive combination vaccines in the United States pediatric vaccine market, with the goal of maximizing each pharmaceutical company's expected revenue. The resulting analysis shows that Pentacel is not competitively priced when compared to Pediarix, its strongest competitor, for federal contract prices ending 31 March 2010. Accordingly, Sanofi Pasteur should expect to generate low revenue upon market entry, while Pediarix remains well priced, with GlaxoSmithKline able to generate a high level of revenue at the expense of Sanofi Pasteur. The proposed pricing approach suggests an appropriate price for Pentacel whereby a substantial increase in expected revenue can be realized.