A cost comparison of introducing and delivering pneumococcal, rotavirus and human papillomavirus vaccines in Rwanda

Wednesday, 25th of November 2015

"costs of introducing new vaccines and costs per girl reached with HPV vaccine are higher than the other two vaccines because of its delivery strategy.”

A cost comparison of introducing and delivering pneumococcal, rotavirus and human papillomavirus vaccines in Rwanda

Ngabo F¹, Levin A², Wang SA³, Gatera M⁴, Rugambwa C⁵, Kayonga C⁶, Donnen P⁷, Lepage P⁸, Hutubessy R⁹.

¹Rwanda Ministry of Health, Kigali, Rwanda; Université Libre de Bruxelles/Ecole de Santé Publique, Belgium.
²Independent Consultant to WHO, 6414 Hollins Dr., Bethesda, MD 20817, United States.
³Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland.
⁴Rwanda Biomedical Center, Kigali, Rwanda.
⁵WHO Rwanda Office, Kigali, Rwanda.
⁶Kigali Institute of Education, Kigali, Rwanda.
⁷Université Libre de Bruxelles/Ecole de Santé Publique, Belgium.
⁸Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Université Libre de Bruxelles, Brussels, Belgium.
⁹Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland. Electronic address: hutubessyr@who.int.

Vaccine. 2015 Oct 29. pii: S0264-410X(15)01437-1. doi: 10.1016/j.vaccine.2015.10.022. [Epub ahead of print]

Abstract below; full text is at http://www.sciencedirect.com/science/article/pii/S0264410X15014371

BACKGROUND:

Detailed cost evaluations of delivery of new vaccines such as pneumococcal conjugate, human papillomavirus (HPV), and rotavirus vaccines in low and middle-income countries are scarce. This paper differs from others by comparing the costs of introducing multiple vaccines in a single country and then assessing the financial and economic impact at the time and implications for the future. The objective of the analysis was to understand the introduction and delivery cost per dose or per child of the three new vaccines in Rwanda to inform domestic and external financial resource mobilization.

METHODS:

Start-up, recurrent, and capital costs from a government perspective were collected in 2012. Since pneumococcal conjugate and HPV vaccines had already been introduced, cost data for those vaccines were collected retrospectively while prospective (projected) costing was done for rotavirus vaccine.

RESULTS:

The financial unit cost per fully immunized child (or girl for HPV vaccine) of delivering 3 doses of each vaccine (without costs related to vaccine procurement) was $0.37 for rotavirus (RotaTeq^®) vaccine, $0.54 for pneumococcal (Prevnar^®) vaccine in pre-filled syringes, and $10.23 for HPV (Gardasil ^®) vaccine. The financial delivery costs of Prevnar^® and RotaTeq^® were similar since both were delivered using existing health system infrastructure to deliver infant vaccines at health centers. The total financial cost of delivering Gardasil^® was higher than those of the two infant vaccines due to greater resource requirements associated with creating a new vaccine delivery system in for a new target population of 12-year-old girls who have not previously been served by the existing routine infant immunization program.

CONCLUSION:

The analysis indicates that service delivery strategies have an important influence on costs of introducing new vaccines and costs per girl reached with HPV vaccine are higher than the other two vaccines because of its delivery strategy. Documented information on financial commitments for new vaccines, particularly from government sources, is a useful input into country policy dialogue on sustainable financing and co-financing of new vaccines, as well as for policy decisions by donors such as Gavi, the Vaccine Alliance.

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