Cost and operational context for national human papillomavirus (HPV) vaccine delivery in six low- and middle-income countries

Mercy Mvundura,Rose Slavkovsky,Frederic Debellut, Teddy Naddumba, Amare Bayeh,Cathy Ndiaye, Jacqueline Anena,Elisabeth Vodicka, Abdou Diop,Deepa Gamage,Clarisse Musanabaganwa, Ganesh Tatkan, Alfred Driwale,Meseret Zelalem,Ousseynou Badiane,Samitha Ginige, Ertenisa Hamilton, Hassan Sibomana, Yohannes Lakew,Francois Uwinkindi, Adugna Dhufera, Immaculate Ampeire,Sandeep Kumar,D. Scott Lamontagne

VACCINE(2023)

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Abstract
Introduction: There are concerns from immunization program planners about high delivery costs for human papillomavirus (HPV) vaccine. Most prior research evaluated costs of HPV vaccine delivery during demonstration projects or at introduction, showing relatively high costs, which may not reflect the costs beyond the pilot or introduction years. This study sought to understand the operational context and estimate delivery costs for HPV vaccine in six national programs, beyond their introduction years.Methods: Operational research and microcosting methods were used to retrospectively collect primary data on HPV vaccination program activities in Ethiopia, Guyana, Rwanda, Senegal, Sri Lanka, and Uganda. Data were collected from the national level and a sample of subnational administrative offices and health facilities. Operational data collected were tabulated as percentages and frequencies. Financial costs (monetary outlays) and economic costs (financial plus opportunity costs) were estimated, as was the cost per HPV vaccine dose delivered. Costing was done from the health system perspective and reported in 2019 United States dollars (US$).Results: Across the study countries, between 53 % and 99 % of HPV vaccination sessions were conducted in schools. Differences were observed in intensity and frequency with which program activities were conducted and resources used. Mean annual economic costs at health facilities in each country ranged from $1,207 to $3,190, while at the national level these ranged from $7,657 to $304,278. Mean annual HPV vaccine doses delivered per health facility in each country ranged from 162 to 761. Mean financial costs per dose per study country ranged from $0.27 to $3.32, while the economic cost per dose ranged from $3.09 to $17.20.
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Key words
Human papillomavirus vaccine,Delivery costing,Microcosting,Vaccine economics,Immunization costing,Operational research,Low,and middle-income countries
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