Costs of delivering human papillomavirus vaccination in Tanzania

Abstract

Background Cervical cancer caused by human papillomavirus (HPV) is the most frequent cancer in women in many low-income countries.Tanzania implemented a national HPV vaccination program in 2018 using a two-dose quadrivalent HPV vaccine. This study aimed to (1) estimate financial and economic costs of a two-dose vaccination program based on experiences with the national vaccination program, (2) estimate costs of a one-dose vaccination schedule to enable future cost-effectiveness analyses, and (3) assess the effect of alternative assumptions for future vaccination coverage rates on estimated costs of vaccination. Methods The WHO Cervical Cancer Prevention and Control Costing (C4P) tool was used to estimate the incremental costs of the national vaccination programme from the perspective of the Tanzanian government using data collected via surveys, workshops, and interviews with local stakeholders. Deterministic sensitivity analyses were performed to estimate the effect of alternative assumptions for coverage rates and delivery strategies and to assess the impact of a potential one-dose vaccination schedule. Results The total financial and economic costs were US$10,117,455 and US$45,683,204, respectively, at a financial cost of $5.17 per two-dose fully immunized girl (FIG), and an economic cost of $23.34 per FIG. Under the assumption of a one-dose vaccination schedule, costs per FIG would reduce to financial costs of $2.51 and economic costs of $12.18. Conclusions The overall cost of Tanzania’s HPV vaccination program was lower per vaccinee than previous demonstration projects in the region suggest. These data provide important baseline data for Tanzania’s HPV vaccination program to date and may serve as a guide for improving coverage going forward. The findings may also aid in the prioritization of funding for countries that have not yet added HPV vaccines to their routine immunizations. Key messages • If a single dose regimen were found to be as effective as a two-dose series, it would result in significant cost savings as well as an increase in the number of girls that could be reached. • School-based vaccinations resulted in the lowest price per fully immunized girl, but other settings are needed to achieve equitable high coverage of HPV vaccination in Tanzania.

Immunogenicity and Safety of One-Dose Human Papillomavirus Vaccine Compared With Two or Three Doses in Tanzanian Girls (DoRIS): An Open-Label, Randomised, Non-inferiority Trial

“…30 Costing data from our study and from the national HPV vaccination programme in Tanzania suggest that a one-dose schedule would be cost-saving and that delivery could be done at costs that would make HPV vaccination a very cost-effective intervention. 31 Study limitations include the sample size that did not allow us to evaluate efficacy of single dose HPV vaccination in this population. However, as has been done for other HPV vaccination studies and following recommendations arising from a WHO-IARC workshop in 2013, we have immunobridged our results to cohorts in which efficacy of a one-dose schedule has been demonstrated, and results are presented in the companion paper.…”

“…The 2-valent HPV vaccine (Cervarix; GSK Biologicals) is an HPV 16 and HPV 18 VLP vaccine containing L1 major capsid proteins of HPV 16 and HPV 18 and a proprietary adjuvant system (ASO4) that is formulated with monophosphoryl-lipid A adsorbed to aluminium hydroxide. The 9-valent vaccine (Gardasil-9; Sanofi Pasteur MSD) targets 9 geno types (HPV 6,11,16,18,31,33,45,52,and 58). The vaccine has an amorphous aluminium hydroxyphosphate sulfate adjuvant and each dose contains 60 μg of HPV 16 L1 protein and 40 μg of HPV 18 L1 protein.…”