RESUMO
Cervical cancer is the second leading cause of cancer deaths among women in Ethiopia. Human papillomavirus (HPV) vaccination is a primary prevention method for cervical cancer and was introduced in Ethiopia in 2018. We conducted a cross-sectional, mixed-methods study to understand the operational context for the HPV vaccination program and the associated costs in three regions of Ethiopia. Operations research provided insights on the frequency and intensity with which HPV vaccination program activities were done, focusing on activities conducted to vaccinate the cohort receiving its first dose in October 2019 and second dose in January 2021. Microcosting was used to estimate the costs to the health system for these activities. Data collection using structured questionnaires was done at 60 health facilities, 17 woredas, and 9 zones/sub-cities that were randomly selected from three purposively selected regions and the national level. Financial costs (monetary outlays) and economic costs (financial costs plus opportunity costs of resource use) were estimated in 2019 US$. Health facilities delivered an average of 411 HPV vaccine doses during the reference period, ranging from a mean of 86 to 606 across the three regions. Aggregated across all levels of the health system, the estimated financial cost per dose across the pooled sample was $2.23, and the economic cost per dose was $7.19, excluding the cost of vaccines and supplies. There were regional variations in these estimates, with mean financial cost per dose ranging from $1.17 to $7.18 and mean economic cost per dose ranging from $5.80 to $18.13 across the three regions. Regional variations exist in the service volume, frequency, and intensity of conducting HPV vaccination activities, as reflected in the estimated costs of delivery. Data generated from this study can be used to inform program planning and budgeting, taking into account regional variations, for effective utilization of resources.
RESUMO
INTRODUCTION: There are concerns from immunization program planners about high delivery costs for human papillomavirus (HPV) vaccine. Most prior research evaluated costs of HPV vaccine delivery during demonstration projects or at introduction, showing relatively high costs, which may not reflect the costs beyond the pilot or introduction years. This study sought to understand the operational context and estimate delivery costs for HPV vaccine in six national programs, beyond their introduction years. METHODS: Operational research and microcosting methods were used to retrospectively collect primary data on HPV vaccination program activities in Ethiopia, Guyana, Rwanda, Senegal, Sri Lanka, and Uganda. Data were collected from the national level and a sample of subnational administrative offices and health facilities. Operational data collected were tabulated as percentages and frequencies. Financial costs (monetary outlays) and economic costs (financial plus opportunity costs) were estimated, as was the cost per HPV vaccine dose delivered. Costing was done from the health system perspective and reported in 2019 United States dollars (US$). RESULTS: Across the study countries, between 53 % and 99 % of HPV vaccination sessions were conducted in schools. Differences were observed in intensity and frequency with which program activities were conducted and resources used. Mean annual economic costs at health facilities in each country ranged from $1,207 to $3,190, while at the national level these ranged from $7,657 to $304,278. Mean annual HPV vaccine doses delivered per health facility in each country ranged from 162 to 761. Mean financial costs per dose per study country ranged from $0.27 to $3.32, while the economic cost per dose ranged from $3.09 to $17.20. CONCLUSION: HPV vaccine delivery costs were lower than at introduction in some study countries. There were differences in the activities carried out for HPV vaccine delivery and the number of doses delivered, impacting the cost estimates.
