Costs of delivering human papillomavirus vaccination to schoolgirls in Mwanza Region, Tanzania

Wilm Quentin, Fern Terris-Prestholt, John Changalucha, Selephina Soteli, W John Edmunds, Raymond Hutubessy, David A Ross, Saidi Kapiga, Richard Hayes, Deborah Watson-Jones, Wilm Quentin, Fern Terris-Prestholt, John Changalucha, Selephina Soteli, W John Edmunds, Raymond Hutubessy, David A Ross, Saidi Kapiga, Richard Hayes, Deborah Watson-Jones

Abstract

Background: Cervical cancer is the leading cause of female cancer-related deaths in Tanzania. Vaccination against human papillomavirus (HPV) offers a new opportunity to control this disease. This study aimed to estimate the costs of a school-based HPV vaccination project in three districts in Mwanza Region (NCT ID: NCT01173900), Tanzania and to model incremental scaled-up costs of a regional vaccination program.

Methods: We first conducted a top-down cost analysis of the vaccination project, comparing observed costs of age-based (girls born in 1998) and class-based (class 6) vaccine delivery in a total of 134 primary schools. Based on the observed project costs, we then modeled incremental costs of a scaled-up vaccination program for Mwanza Region from the perspective of the Tanzanian government, assuming that HPV vaccines would be delivered through the Expanded Programme on Immunization (EPI).

Results: Total economic project costs for delivering 3 doses of HPV vaccine to 4,211 girls were estimated at about US$349,400 (including a vaccine price of US$5 per dose). Costs per fully-immunized girl were lower for class-based delivery than for age-based delivery. Incremental economic scaled-up costs for class-based vaccination of 50,290 girls in Mwanza Region were estimated at US$1.3 million. Economic scaled-up costs per fully-immunized girl were US$26.41, including HPV vaccine at US$5 per dose. Excluding vaccine costs, vaccine could be delivered at an incremental economic cost of US$3.09 per dose and US$9.76 per fully-immunized girl. Financial scaled-up costs, excluding costs of the vaccine and salaries of existing staff were estimated at US$1.73 per dose.

Conclusions: Project costs of class-based vaccination were found to be below those of age-based vaccination because of more eligible girls being identified and higher vaccine uptake. We estimate that vaccine can be delivered at costs that would make HPV vaccination a very cost-effective intervention. Potentially, integrating HPV vaccine delivery with cost-effective school-based health interventions and a reduction of vaccine price below US$5 per dose would further reduce the costs per fully HPV-immunized girl.

Figures

Figure 1
Figure 1
Contribution of project activities to total economic project costs (year 2011, US$).
Figure 2
Figure 2
Project economic costs (year 2011 US$) per fully-immunized girl by school location and vaccination strategy. Data for the Figure are available in Additional file 1, Table S4.
Figure 3
Figure 3
Scaled-up class-based vaccination program: sensitivity analysis of incremental economic costs per fully-immunized girl (2011 US$).

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