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Background: There is limited evidence on the magnitude of the potential program cost savings associated with the World Health Organization-endorsed single-dose schedule for the human papillomavirus (HPV) vaccine. The objective of this analysis was to model the delivery and vaccine procurement cost implications of the new schedule., Methods: The analysis leveraged primary data during a study evaluating the HPV vaccine delivery costs and operational context in 5 countries (Ethiopia, Guyana, Rwanda, Sri Lanka, and Uganda) implementing a two-dose schedule. To estimate the cost for the single-dose schedule, we adjusted the two-dose schedule cost estimates to account for differences in the frequency of activities, whether activities differed by HPV vaccine dose or session, and differences in relative quantity or storage volume of HPV vaccines delivered. We estimated the cost per dose and cost per adolescent receiving the full (single-dose or two-dose) vaccination schedule in 2019 US dollars from a health system perspective., Results: Modeled results found that cost per dose would increase under a single-dose schedule, whereas cost per adolescent receiving the full schedule would decrease. The financial cost for vaccine procurement and delivery per adolescent receiving the full schedule ranged from $9.64 (Sri Lanka) to $23.43 (Guyana) under a two-dose schedule and decreased to $4.84 and $12.34, respectively, under a single-dose schedule, reflecting savings up to 50%. For economic costs, the range for a single-dose schedule was $7.86 (Rwanda) to $28.53 (Guyana)., Conclusion: A single-dose HPV vaccination schedule could provide cost savings to immunization programs and enhance program affordability and sustainability., (© The Author(s) 2024. Published by Oxford University Press.)

Evidence on determinants of vaccine delivery costs can inform program design and planning. Given the dearth of this evidence for human papillomavirus (HPV) vaccine, we conducted an analysis to identify programmatic and operational factors that are statistically associated with variations in economic costs for HPV vaccine delivery, within and across six low- and middle-income countries. HPV vaccine program operations and cost data were collected from Ethiopia, Guyana, Rwanda, Senegal, Sri Lanka, and Uganda. An ordinary least square regression analysis was done using data from 279 health facilities in these six countries. We ran country-specific and pooled multivariate linear regressions. A conditional regression including 228 facilities was also run. The dependent variable was the estimated total economic costs for HPV vaccine delivery per facility, excluding vaccine procurement costs. Explanatory variables included number of HPV vaccine doses delivered; numbers of vaccination sessions conducted, and schools served; distance traveled by health workers for vaccine delivery; intensity of conducting program activities; human resource (health workers, school staff, etc.) utilization rates; and categorical variables indicating whether per diems were paid, and for country-specific dummies; Explanatory variables such as the number of program activities or meetings held, receipt of per diems, and utilization rates of health workers, were all positively and statistically significantly associated with economic costs in the pooled sample, for both the unconditional and conditional regressions. Variables such as the doses delivered, and number of sessions conducted were statistically significant in the unconditional regression. The within-country regression found that only variations in utilization rates of health workers were statistically significant in all countries. Our analysis provides evidence to HPV vaccination program stakeholders on which program context variables impact costs, which can inform program adjustment to improve cost efficiency, especially as programs managers work to revitalize and rebuild HPV vaccine coverage after the COVID-19 pandemic., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

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., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)