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Costs associated with delivering HPV vaccination in the context of the first year demonstration programme in southern Mozambique

BACKGROUND: In Mozambique cervical cancer is a public health threat, due to its high incidence and limited access to early diagnosis of precancerous lesions. International organisations are supporting the introduction of human papillomavirus (HPV) vaccines in low- and middle-income countries. Some o...

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Autores principales: Alonso, Sergi, Cambaco, Olga, Maússe, Yolanda, Matsinhe, Graça, Macete, Eusébio, Menéndez, Clara, Sicuri, Elisa, Sevene, Esperança, Munguambe, Khátia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676560/
https://www.ncbi.nlm.nih.gov/pubmed/31370810
http://dx.doi.org/10.1186/s12889-019-7338-4
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author Alonso, Sergi
Cambaco, Olga
Maússe, Yolanda
Matsinhe, Graça
Macete, Eusébio
Menéndez, Clara
Sicuri, Elisa
Sevene, Esperança
Munguambe, Khátia
author_facet Alonso, Sergi
Cambaco, Olga
Maússe, Yolanda
Matsinhe, Graça
Macete, Eusébio
Menéndez, Clara
Sicuri, Elisa
Sevene, Esperança
Munguambe, Khátia
author_sort Alonso, Sergi
collection PubMed
description BACKGROUND: In Mozambique cervical cancer is a public health threat, due to its high incidence and limited access to early diagnosis of precancerous lesions. International organisations are supporting the introduction of human papillomavirus (HPV) vaccines in low- and middle-income countries. Some of these countries recently conducted demonstration programmes, which included evaluation of acceptability, coverage, and practicality of implementation and of integration in existing programmes. Information on costs of delivering the vaccine is needed to overcome the challenges of reaching vaccine potential recipients in rural and remote areas. METHODS: We estimated the financial and economic costs of delivering HPV vaccination to ten-year-old girls at schools for the first vaccination cycle of the demonstration programme in the Manhiça district (southern Mozambique), delivered throughout 2014. We also estimated costs of an alternative scenario with a reduced number of doses and personnel, which was analogous to the second vaccination cycle delivered throughout 2015. Cost estimates followed a micro-costing approach and included interviews with key informants at different administrative levels through the administration of standard questionnaires developed by the World Health Organisation. RESULTS: Considering only data from the first vaccination cycle (2014), which consisted in the administration of three doses, the average economic cost was US$17.59 per dose and US$52.29 per fully-immunised girl (FIG). Financial cost per dose (US$6.07) and per FIG (US$17.95) were substantially lower. The economic cost was US$15.53 per dose and US$31.14 per FIG when estimating an alternative cost scenario with reduced number of doses and personnel. CONCLUSIONS: The average economic cost per dose was lower than the ones recently reported for low- and middle-income countries. However, our estimation of the financial cost per FIG was higher than the ones observed elsewhere (ranging from US$2.49 in India to US$20.36 in Vietnam) due to the high percentage of out-of-school girls which, reduced vaccine coverage and, therefore, reduced the denominator. Due to budget constraints, if Mozambique is to implement nation-wide HPV vaccination targeted to ten-year-old girls at schools, a reduction in personnel costs should be operated either by restricting the outreach vaccinator team or the number of supervision visits. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12889-019-7338-4) contains supplementary material, which is available to authorized users.
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spelling pubmed-66765602019-08-06 Costs associated with delivering HPV vaccination in the context of the first year demonstration programme in southern Mozambique Alonso, Sergi Cambaco, Olga Maússe, Yolanda Matsinhe, Graça Macete, Eusébio Menéndez, Clara Sicuri, Elisa Sevene, Esperança Munguambe, Khátia BMC Public Health Research Article BACKGROUND: In Mozambique cervical cancer is a public health threat, due to its high incidence and limited access to early diagnosis of precancerous lesions. International organisations are supporting the introduction of human papillomavirus (HPV) vaccines in low- and middle-income countries. Some of these countries recently conducted demonstration programmes, which included evaluation of acceptability, coverage, and practicality of implementation and of integration in existing programmes. Information on costs of delivering the vaccine is needed to overcome the challenges of reaching vaccine potential recipients in rural and remote areas. METHODS: We estimated the financial and economic costs of delivering HPV vaccination to ten-year-old girls at schools for the first vaccination cycle of the demonstration programme in the Manhiça district (southern Mozambique), delivered throughout 2014. We also estimated costs of an alternative scenario with a reduced number of doses and personnel, which was analogous to the second vaccination cycle delivered throughout 2015. Cost estimates followed a micro-costing approach and included interviews with key informants at different administrative levels through the administration of standard questionnaires developed by the World Health Organisation. RESULTS: Considering only data from the first vaccination cycle (2014), which consisted in the administration of three doses, the average economic cost was US$17.59 per dose and US$52.29 per fully-immunised girl (FIG). Financial cost per dose (US$6.07) and per FIG (US$17.95) were substantially lower. The economic cost was US$15.53 per dose and US$31.14 per FIG when estimating an alternative cost scenario with reduced number of doses and personnel. CONCLUSIONS: The average economic cost per dose was lower than the ones recently reported for low- and middle-income countries. However, our estimation of the financial cost per FIG was higher than the ones observed elsewhere (ranging from US$2.49 in India to US$20.36 in Vietnam) due to the high percentage of out-of-school girls which, reduced vaccine coverage and, therefore, reduced the denominator. Due to budget constraints, if Mozambique is to implement nation-wide HPV vaccination targeted to ten-year-old girls at schools, a reduction in personnel costs should be operated either by restricting the outreach vaccinator team or the number of supervision visits. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12889-019-7338-4) contains supplementary material, which is available to authorized users. BioMed Central 2019-08-01 /pmc/articles/PMC6676560/ /pubmed/31370810 http://dx.doi.org/10.1186/s12889-019-7338-4 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Alonso, Sergi
Cambaco, Olga
Maússe, Yolanda
Matsinhe, Graça
Macete, Eusébio
Menéndez, Clara
Sicuri, Elisa
Sevene, Esperança
Munguambe, Khátia
Costs associated with delivering HPV vaccination in the context of the first year demonstration programme in southern Mozambique
title Costs associated with delivering HPV vaccination in the context of the first year demonstration programme in southern Mozambique
title_full Costs associated with delivering HPV vaccination in the context of the first year demonstration programme in southern Mozambique
title_fullStr Costs associated with delivering HPV vaccination in the context of the first year demonstration programme in southern Mozambique
title_full_unstemmed Costs associated with delivering HPV vaccination in the context of the first year demonstration programme in southern Mozambique
title_short Costs associated with delivering HPV vaccination in the context of the first year demonstration programme in southern Mozambique
title_sort costs associated with delivering hpv vaccination in the context of the first year demonstration programme in southern mozambique
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676560/
https://www.ncbi.nlm.nih.gov/pubmed/31370810
http://dx.doi.org/10.1186/s12889-019-7338-4
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