Cost of a human papillomavirus vaccination project, Zimbabwe.

Anna Hidle,Gwati Gwati,Deborah Mcfarland,Taiwo Abimbola,Amos Petu,Portia Manangazira,Sarah W Pallas,Terri Hyde

doi:10.2471/blt.18.211904

Abstract

ObjectiveTo determine the cost of Zimbabwe’s human papillomavirus (HPV) vaccination demonstration project.MethodsThe government of Zimbabwe conducted the project from 2014–2015, delivering two doses of HPV vaccine to 10-year-old girls in two districts. School delivery was the primary vaccination strategy, with health facilities and outreach as secondary strategies. A retrospective cost analysis was conducted from the provider perspective. Financial costs (government expenditure) and economic costs (financial plus the value of existing or donated resources including vaccines) were calculated by activity, per dose and per fully immunized girl.ResultsThe project delivered 11 599 vaccine doses, resulting in 5724 fully immunized girls (5540 at schools, 168 at health facilities and 16 at outreach points). The financial cost for service delivery per fully immunized girl was United States dollars (US$) 5.34 in schools, US$ 34.90 at health facilities and US$ 288.63 at outreach; the economic costs were US$ 17.39, US$ 41.25 and US$ 635.84, respectively. The mean financial cost per dose was US$ 19.76 and per fully immunized girl was US$ 40.03 (economic costs were US$ 45.00 and US$ 91.19, respectively). The largest number of doses delivered (5788) occurred during the second vaccination round (the second group’s first dose concurrently delivered with the first group’s second dose), resulting in the lowest financial and economic service delivery costs per dose: US$ 1.97 and US$ 6.79, respectively.ConclusionThe mean service delivery cost was lower in schools (primary strategy) and when more girls were vaccinated in each round, demonstrating scale efficiency.

Highlights

Each year 266 000 women worldwide die of cervical cancer due to human papillomavirus (HPV) infection.[1,2]
The World Health Organization (WHO) recommends that all countries add the HPV vaccine to their national immunization programme, selecting a delivery strategy that is feasible with the current health infrastructure, affordable, cost–effective, sustainable and capable of achieving high coverage.[6]
The mean financial cost per dose for the overall project was US$ 19.76 and the mean economic cost per dose was US$ 45.00 (Table 3)

Summary

Introduction

Each year 266 000 women worldwide die of cervical cancer due to human papillomavirus (HPV) infection.[1,2] Cervical cancer is the fourth leading cause of estimated cancer deaths worldwide among women, most of which occur in low- and middle-income countries; the total is projected to increase to 416 000 deaths by 2035.1,3,4 Low- and middle-income countries account for 84% (444 500 out of 527 600) of the world’s cervical cancer burden.[2,4] HPV infection, one of the most common sexually transmitted diseases worldwide, is known as the main cause of cervical cancer, with HPV types 16 and 18 causing most cervical cancer cases.[5]. Zimbabwe’s national health strategy and cancer prevention and control strategies mention HPV vaccination as a way to avert cervical cancer.[9,10]

Methods

Results

Conclusion