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TRANSCRIPT
Costs of delivering HPV vaccine
to school girls in Tanzania
Wilm Quentin1, Deborah Watson-Jones2,3, John
Changalucha4, Raymond Hutubessy5, John Edmunds2,
Richard Hayes2, Saidi Kapiga3, Fern Terris-Prestholt2
1 Berlin University of Technology (TUB), Berlin, Germany2 London School of Hygiene and Tropical Medicine (LSHTM), London, UK3 Mwanza Intervention Trials Unit (MITU), Mwanza, Tanzania 4 National Institute for Medical Research (NIMR), Mwanza, Tanzania5 Initiative for Vaccines Research, World Health Organization, Geneva, Switzerland
Background
� Tanzania has the highest rate of cervical cancer in sub-Saharan Africa
� Plans for introduction of HPV vaccines in Tanzania and other African countries
� GAVI negotiated price � GAVI negotiated price reductions for GAVI-eligible developing countries
� Project in MwanzaRegion to prepare for national programme: feasibility, uptake, acceptability of HPV vaccination – and costs!
Aims of the costing study
1. Estimate the costs of a school-based HPV vaccination project in Mwanza, Tanzania
2. Explore cost differences between delivering HPV vaccine to rural and urban schools and between two alternative school-based delivery strategiestwo alternative school-based delivery strategies
3. Estimate incremental costs of a scaled-up vaccination programme for Mwanza Region
Methods: Overview
� Part I: Resource use and cost data collected alongside the Mwanza vaccination project.
� Part II: Estimate costs of scaled-up programme for Mwanza region.Mwanza region.
� Definitions:
� Financial costs: actual expenditures on goods and services used in the intervention
� Economic costs: the value of all resources used including costs of donated goods and services
Methods: Part I: Setting
� Phase IV cluster (school) randomised trial (Watson-Jones et al. O-04.03)
� Mwanza city (2 districts) & Misungwi district
� Two delivery strategies:
� Age-based (born in 1998)
� Class-based (girls in standard 6 in 2010)� Class-based (girls in standard 6 in 2010)
Table 1: Number of vaccinated schools and girls vaccinated with dose 3
Delivery Strategy
Total School location Age-based
Vaccination
Class-based
vaccination
schools girls schools girls Schools girls
Rural 30 777 30 1,178 60 1,955
Urban 34 795 36 1.461 70 2,256
Total 64 1,572 66 2,639 130 4,211
Methods: Part 1
� Data collection: Project management accounts, interviews, observations, logbook analysis, timesheets.
� All resources used by the project were allocated to activities, i.e. preparations, social mobilization/IEC, training, cold chain storage, vaccination (4 rounds), waste management, and administration/supervision. waste management, and administration/supervision.
� Costs of research were excluded.
� Costs of vaccines were not included.
� Calculation was done for total project costs, costs per school and costs per fully immunized girl.
Methods: Part 2
� Incremental costs of a scaled-up vaccination programme were estimated using an ingredients approach.
� The Mwanza HPV vaccine project, WHO Planning and Costing tool (Levin et al. P05-29), and interviews with regional and district EPI staff provided information regional and district EPI staff provided information about necessary ingredients.
� Unit costs were available from the project cost analysis and WHO Planning and Costing tool.
� A model was constructed to estimate scale-up costs for vaccination of eligible girls in Mwanza region (about 48,400 girls) using class-based delivery
Results: Mwanza Vaccine Project
7%5%
2%
Total Economic Project CostsUS$ 300,500 Preparation
Social Mobilization/IECTraining
1
30%
4%
0.03%
50%
Vaccination
Cold Storage
Waste Management
Admin/Supervision
1 Preparation refers to determining the number of eligible girls per school
Results: Mwanza Vaccine Project
US$ 60
US$ 80
US$ 100
Economic Costs per Fully Immunized Girl
Preparation
Social mobilization/IEC
Training
US$ 87
US$ 52
US$ 98
US$ 67
US$ 0
US$ 20
US$ 40
US$ 60
age-based class-based age-based class-based
urban rural
Vaccination
Cold Storage
Waste Management
Admin/Supervision
US$ 52
Results: Regional Program
US$ 500,000
US$ 600,000
US$ 700,000
US$ 800,000
Total Programme costs Mwanza Region
Social Mobilization/IEC
Training
Procurment
US$ 683,633
US$ 437,130
US$ 0
US$ 100,000
US$ 200,000
US$ 300,000
US$ 400,000
Financial (USD) Economic (USD)
Vaccination
Cold Storage
Waste Management
Admin/Supervision
Results: Comparison: Region vs. Project
US$ 30
US$ 40
US$ 50
US$ 60
Economic Costs per Fully Immunized Girl
Preparation
Social Mobilization
Training
Procurment
US$ 52
US$ 0
US$ 10
US$ 20
US$ 30
all girlsMwanza region
class-based urban Project
Vaccination
Cold Storage
Waste Management
Admin/Supervision
US$ 18
Discussion
� Costs for class-based delivery were found to be much lower than for age-based delivery.
� Costs in a national vaccination programme are estimated to be much lower than costs calculated for the Mwanza HPV Vaccine Project.
� Scale-up cost results are similar to those from WHO Planning and Costing tool but somewhat higher than PATH’s estimates for Uganda (Levin et al. O-01.07).
� Economic costs per fully immunized girl would increase to US$ 35 if an HPV vaccine price of US$ 5 (per dose) was included.
Conclusions
� This is one of the first costing analyses of HPV vaccination in school-girls in Africa.
� Economic costs of vaccine delivery per Fully Immunized Girl were estimated to be US$ 18 in a scaled-up class-based vaccination program. scaled-up class-based vaccination program.
� Costs for delivering vaccines need to be adequately taken into account by governments when deciding about introduction of HPV vaccination.
Acknowledgements
MITU: Selephina Soteli, Riziki Ponsiano, HPV vaccine
team, Jacqueline Jackson
LSHTM: Tamara Hurst, Eleanor Martins, P Mayaud, K
Baisley
Ocean Road Cancer Institute (ORCI): T Ngoma
Tanzania Expanded Programme on Immunization: D Tanzania Expanded Programme on Immunization: D
Lyimo
International Union against Cancer (UICC): J Torode
TU Berlin: R Busse, N Kurth
Funding: Wellcome Trust, WHO, UICC
Vaccines: Axios Healthcare Development - GARDASIL®
Access Program
Disclosure
� Wilm Quentin: no conflict of interests
� Results of this study were generated in the context of a � Results of this study were generated in the context of a project that received vaccines through the Gardasil Access Program.