Department of Health Care Management, Berlin University of Technology, Strasse des 17 Juni 135, Berlin, 10623, Germany.
BMC Med. 2012 Nov 13;10:137. doi: 10.1186/1741-7015-10-137.
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.
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).
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.
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.
在坦桑尼亚，宫颈癌是导致女性癌症相关死亡的主要原因。人乳头瘤病毒（HPV）疫苗的接种为控制这种疾病提供了新的机会。本研究旨在估计姆万扎地区三个区（NCT ID：NCT01173900）基于学校的 HPV 疫苗接种项目的成本，并对区域疫苗接种计划的增量扩展成本进行建模。
我们首先对疫苗接种项目进行自上而下的成本分析，比较了在总共 134 所小学中基于年龄（1998 年出生的女孩）和基于班级（6 年级）的疫苗接种的实际项目成本。基于观察到的项目成本，我们从坦桑尼亚政府的角度对姆万扎地区扩大疫苗接种计划的增量成本进行了建模，假设 HPV 疫苗将通过扩大免疫规划（EPI）提供。
为 4211 名女孩接种 3 剂 HPV 疫苗的总经济项目成本估计约为 34.94 万美元（包括每剂 5 美元的疫苗价格）。基于班级的接种成本低于基于年龄的接种成本。在姆万扎地区对 50290 名女孩进行基于班级的疫苗接种的增量经济扩展成本估计为 130 万美元。每例完全免疫女孩的经济扩展成本为 26.41 美元，包括每剂 5 美元的 HPV 疫苗。不包括疫苗成本，疫苗可以以每剂 3.09 美元和每例完全免疫女孩 9.76 美元的增量经济成本进行接种。不包括疫苗成本和现有工作人员工资的财务扩展成本估计为每剂 1.73 美元。
基于班级的疫苗接种项目成本低于基于年龄的疫苗接种项目成本，因为更多符合条件的女孩被识别出来，疫苗接种率更高。我们估计，疫苗接种的成本将使 HPV 疫苗接种成为一种非常具有成本效益的干预措施。潜在地，将 HPV 疫苗接种与具有成本效益的基于学校的卫生干预措施相结合，并将疫苗价格降低到每剂 5 美元以下，将进一步降低每例完全 HPV 免疫女孩的成本。
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