title: The costs of delivering human papillomavirus vaccination to Grade 4 learners in KwaZulu-Natal, South Africa.
abstract: BACKGROUND
  The national human papillomavirus (HPV) vaccination roll-out in South Africa provides two doses of Cervarix to all female Grade 4 learners in state schools. This study estimated the costs of vaccinating all learners in KwaZulu-Natal Province (females or males and females) using either the two- or three-dose strategies for both the bivalent and quadrivalent vaccines.
  
  
  OBJECTIVE
  To determine costs of the HPV vaccination programme in KwaZulu-Natal.
  
  
  METHODS
  Costs were determined adapting World Health Organization vaccination costing guidelines.
  
  
  RESULTS
  The 2014 current cost of delivering three doses of Gardasil was ZAR510 per learner. The projected cost of delivering Cervarix to female learners at two or three doses over the period 2014 - 2018, adjusted for inflation, was ZAR172 717 342 and ZAR250 048 426, respectively. Similarly, the cost for Gardasil at these doses was ZAR197 482 200 and ZAR287 194 361, respectively. For male and female learners the cost for Cervarix over this period at two or three doses was ZAR337 101 132 and ZAR540 150 713, respectively. Similarly, the cost for Gardasil at these doses was ZAR426 597 971 and ZAR620 392 784, respectively. Accounting for population variation for females over 5 years, the cost of two doses of Cervarix ranged from ZAR168 888 677 to ZAR 176 545 977 at the lower and upper 95% confidence intervals (CIs), respectively. For three doses the cost ranged from ZAR244 505 544 to ZAR255 591 263 at the lower and upper 95% CIs, respectively. Similarly, the cost for two doses of Gardasil ranged from ZAR193 104 566 to ZAR201 859 798. For three doses the cost ranged from ZAR280 828 057 to ZAR293 560 614.
  
  
  CONCLUSIONS
  This study gives decision makers a basis for structured planning and cost apportionment to ensure effective roll-out of the HPV vaccination programme.
authors.affiliation: Health Outcomes Research Unit, Discipline of Public Health Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa. moodleyi15@ukzn.ac.za.
authors.forename: Indres
authors.initials: I
authors.lastname: Moodley
authors.forename: Nerisha
authors.initials: N
authors.lastname: Tathiah
authors.forename: Ben
authors.initials: B
authors.lastname: Sartorius