Cervical cancer is the fourth most common cancer among women globally, and more than 95 percent of cases can be attributed to HPV infection. Though they have been available since 2006, HPV vaccines remain out of reach for adolescents in many low- and middle-income countries (LMICs). This may be partly due to a lack of information about the full cost of HPV vaccination programs and the potential cost-savings that could be experienced when countries introduce the vaccine. PATH works on several fronts to inform and demonstrate the health and economic benefits of HPV vaccination to support country decision-making.
Estimating the costs of HPV vaccine delivery
There are limited data on the cost of HPV vaccine delivery in national programs beyond the introduction years. Previous research has focused mainly on the costs of introduction or demonstration projects. Improved understanding of recurrent HPV vaccination program costs and the operational context in LMICs could help inform future HPV vaccine introductions.
PATH conducted a study in collaboration with ministries of health and other local partners in Ethiopia, Guyana, Rwanda, Senegal, Sri Lanka, and Uganda to generate evidence on the ongoing annual costs (excluding the costs of vaccines and supplies) to deliver a two-dose HPV vaccination schedule.
Results from the study were presented this week at the 15th Annual Health Economics Association Congress in Cape Town, South Africa. One session featured four presentations from PATH colleagues sharing key lessons from various aspects of the study.
“We explored how program context can influence costs in routinized national-level HPV immunization programs,” explained Mercy Mvundura, PhD, Health Economics Technical Advisor at PATH and the session organizer. “We also sought to answer policy-relevant questions, such as the potential cost implications of switching to a single-dose schedule, the costs of different delivery locations, and the impact of the COVID-19 pandemic on program costs.”
“As countries make decisions about HPV vaccination schedules and how to allocate public health spending, a nuanced understanding of program costs and drivers will be key to ensuring sustainability.”— Rose Slavkovsky, MPA, Health Economics Program Officer at PATH
“Evidence on how HPV vaccine program context impacts delivery costs will inform program planning and budgeting for country- and global-level stakeholders,” said Rose Slavkovsky, MPA, Health Economics Program Officer at PATH and another presenter at the session. “As countries make decisions about HPV vaccination schedules and how to allocate public health spending, a nuanced understanding of program costs and drivers will be key to ensuring sustainability.”
The World Health Organization endorsed switching to a single-dose schedule last December, which holds particular promise for countries looking to reduce HPV vaccination costs. PATH recently joined other global partners in signing onto a statement to raise awareness about the potential impact of a single-dose HPV vaccine schedule in reaching more girls and protecting more women against cervical cancer.
Weighing different options
Determining the cost of vaccine delivery is only part of the challenge when it comes to establishing an HPV vaccination program. Because there are multiple HPV vaccine products available, it is essential for countries to understand the cost-effectiveness of each option when considering HPV vaccine introduction or switching to a different product or schedule.
Cost-effectiveness examines the costs and health impact of one or more interventions by comparing them to each other and to the status quo to determine whether the intervention is a good use of resources. PATH is conducting several country-led HPV vaccine impact and cost-effectiveness analyses to help local leaders estimate long-term health, economic, and financial impacts and decide which vaccine products and schedules will be most appropriate and sustainable.
These studies not only confirm the cost-effectiveness of HPV vaccines, but also demonstrate the potential to enhance value for money through new vaccine products or a single-dose schedule. Results are currently available for the Philippines, Mozambique, and Kenya, with additional countries to follow.
PATH’s HPV Vaccine Cost Calculator is another important tool for country decision-makers and technical assistance partners. The calculator assesses and compares vaccination program costs annually and for a period of 10 years for the HPV vaccine options currently available in the global market. Any country can use it, and it provides estimates for Gavi-eligible pricing. In addition, if countries want to compare the potential cost consequences of switching to a single-dose schedule, the calculator provides high-level estimates of these costs with only a few data points required from users.
“It’s great to have so many effective HPV vaccine options, but it can be challenging when it comes to choosing which one is best for a particular country’s circumstances.”— Clint Pecenka, PhD, Director of Health Economics at PATH
“It’s great to have so many effective HPV vaccine options, but it can be challenging when it comes to choosing which one is best for a particular country’s circumstances,” said Clint Pecenka, PhD, PATH’s Director of Health Economics. “Our recent work on the cost calculator and country-led impact and cost-effectiveness analyses reflects the evolving choices for HPV vaccination programs, including new products entering the market and additional schedule flexibility.”
Economic analyses can also have a role in assessing other cervical cancer prevention methods. For instance, we’re completing studies to evaluate health system barriers and opportunities for cervical cancer prevention in Zambia, and to evaluate the cost of cervical cancer and precancer screening and treatment in Senegal. Results for both will be available soon.
Using economics to guide decision-making
The economics of HPV vaccination may seem complicated, but translating the results of these types of studies into accessible data points can lead to critical health systems decisions and changes. Whether they’re considering HPV vaccine for the first time or have been providing it for years, countries need tools that can help them examine the economic benefits of different products and schedules—especially as new vaccines become available and policy recommendations evolve and change.
“Vaccines may be one of the best buys in public health, but it’s not as simple as saying ‘yes’ to every new vaccine or schedule change that comes along,” says Dr. Pecenka. “Making sense of health economic assessments can help ensure HPV vaccination decisions not only save lives and improve health but also make good financial sense.”
