Cost analysis of the school-based human papillomavirus vaccination programme in Tshwane Health District, South Africa

Abstract

Background. Cervical cancer is a significant public health concern globally. Persistent infection with high-risk human papillomavirus (HPV) types is the necessary cause of virtually all cervical cancers, although rare HPV-negative cervical cancer cases have been reported. HPV is one of the most common sexually transmitted infections worldwide and is responsible for approximately 90% of all cervical cancer cases globally. Objectives. To estimate the financial costs and cost per fully vaccinated girl (FVG) of the school-based HPV vaccination programme in Tshwane Health District, South Africa. Methods. We conducted a cross-sectional cost analysis of the 2019 vaccination campaign using the World Health Organization Cancer Prevention and Control Costing (C4P) tool. The data for the programme were obtained from the District Health Information System and financial records. Costs were categorised by component and converted to USD. Results. The programme reached 15 734 girls with two doses (71.3% uptake). The total financial cost was ZAR21 127 298 (USD1 458 704). Service delivery (71.8%) and vaccine procurement (27.1%) were the main cost drivers. The cost per FVG was ZAR1 343 (USD92.94). Conclusion. The Tshwane school-based HPV vaccination programme had a high financial cost per FVG compared with other low- and middle-income countries, largely owing to staffing and procurement costs. Optimising delivery strategies can improve cost-efficiency and sustainability.