title: Costs of delivering human papillomavirus vaccination to schoolgirls in Mwanza Region, Tanzania.
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.
authors.affiliation: Department of Health Care Management, Berlin University of Technology, Strasse des 17 Juni 135, Berlin, 10623, Germany. wilm.quentin@tu-berlin.de
authors.forename: Wilm
authors.initials: W
authors.lastname: Quentin
authors.forename: Fern
authors.initials: F
authors.lastname: Terris-Prestholt
authors.forename: John
authors.initials: J
authors.lastname: Changalucha
authors.forename: Selephina
authors.initials: S
authors.lastname: Soteli
authors.forename: W John
authors.initials: WJ
authors.lastname: Edmunds
authors.forename: Raymond
authors.initials: R
authors.lastname: Hutubessy
authors.forename: David A
authors.initials: DA
authors.lastname: Ross
authors.forename: Saidi
authors.initials: S
authors.lastname: Kapiga
authors.forename: Richard
authors.initials: R
authors.lastname: Hayes
authors.forename: Deborah
authors.initials: D
authors.lastname: Watson-Jones
mesh_terms: D000293:Adolescent; D002648:Child; D003365:Costs and Cost Analysis / Q000379:methods; D005260:Female; D006291:Health Policy / Q000191:economics; D006801:Humans; D017589:Immunization Programs / Q000191:economics; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000191:economics*; D012574:Schools; D013636:Tanzania / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000517:prevention & control*
chemical_list: D053918:Papillomavirus Vaccines