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

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

doi:10.1186/1741-7015-10-137

Abstract

BackgroundCervical 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.MethodsWe 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).ResultsTotal 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.ConclusionsProject 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.

Highlights

Cervical cancer is the leading cause of female cancer-related deaths in Tanzania
Based on the observed project costs, incremental costs of a scaled-up vaccination program for Mwanza Region were modeled from the perspective of the Tanzanian government, under the assumption that human papillomavirus (HPV) vaccines would be delivered through the Expanded Programme on Immunization (EPI)
Analysis of project costs Total project costs Total economic project costs for delivering 3 doses of HPV vaccine to 4,211 girls in Mwanza City and Misungwi district were estimated to be US$349,000 (Figure 1). (Data for financial and economic costs and for project costs by cost category are available in Additional file 1, Table S3.) Administration/supervision accounted for 42% of total project costs

Summary

Introduction

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. Cervical cancer is the second most frequent cancer in women worldwide [1]. In Tanzania, as in much of sub-Saharan Africa, cervical cancer is the leading cause of female cancer deaths [3,4]. Human papillomaviruses (HPV) are the etiological agents of cervical cancers [5], and vaccines against HPV (types 16 and 18) offer the opportunity to prevent about 70% of cervical cancer cases worldwide [6]. Many high-income countries have national HPV vaccination programs [7], and Tanzania plans to start a national HPV vaccination program in late 2012 [8]. Following the November 2011 decision of the Global Alliance for Vaccines and Immunisations (GAVI) to move towards funding HPV vaccines for eligible countries [9], HPV vaccination could become an option in many countries where HPV vaccines are currently unaffordable

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