Mvundura Mercy, Bayeh Amare, Zelalem Meseret, Lakew Yohannes, Dhufera Adugna, Dagnew Belayneh, Slavkovsky Rose, Lamontagne D Scott
Medical Devices and Health Technologies, PATH, Seattle, Washington, United States of America.
Ethiopia Country Office, PATH, Addis Ababa, Ethiopia.
PLOS Glob Public Health. 2024 Jul 15;4(7):e0003357. doi: 10.1371/journal.pgph.0003357. eCollection 2024.
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.
宫颈癌是埃塞俄比亚女性癌症死亡的第二大主要原因。人乳头瘤病毒（HPV）疫苗接种是预防宫颈癌的主要方法，于2018年引入埃塞俄比亚。我们开展了一项横断面混合方法研究，以了解埃塞俄比亚三个地区HPV疫苗接种项目的实施情况及其相关成本。运筹学提供了关于HPV疫苗接种项目活动开展频率和强度的见解，重点关注2019年10月接种第一剂疫苗和2021年1月接种第二剂疫苗的队列的接种活动。微观成本核算用于估算卫生系统开展这些活动的成本。使用结构化问卷在60个卫生设施、17个县和9个区/次城市收集数据，这些地区是从三个有目的选择的地区和国家层面随机选取的。以2019年美元估算财务成本（货币支出）和经济成本（财务成本加上资源使用的机会成本）。在参考期间，卫生设施平均提供411剂HPV疫苗，三个地区的平均值从86剂到606剂不等。在卫生系统的所有层面汇总后，汇总样本中每剂的估计财务成本为2.23美元，每剂的经济成本为7.19美元，不包括疫苗和用品的成本。这些估计存在地区差异，三个地区每剂的平均财务成本从1.17美元到7.18美元不等，每剂的平均经济成本从5.80美元到18.13美元不等。HPV疫苗接种活动的服务量、频率和强度存在地区差异，这反映在估计的交付成本中。本研究生成的数据可用于为项目规划和预算提供信息，同时考虑地区差异，以有效利用资源。
