Costs of HPV vaccination programs in low- and middle-income countries: A systematic review

Human papillomavirus (HPV) infection is a public health concern, particularly (not exclusively) for women's health, especially in low- and middle-income countries (LMICs). HPV vaccination provides effective prevention against HPV infection and reduces the risk of cervical cancer. This paper aims to systematically review the costs and cost drivers associated with introducing and implementing HPV vaccination programs in LMICs.

We conducted a systematic review by searching the PubMed database for studies since 2000. The search terms used were those associated with (1) HPV, (2) vaccination, (3) cost, and (4) LMICs. The country characteristics and cost components of the HPV vaccination were synthesized.

A total of 19 articles covering 26 countries were included in this systematic review, 16 of which were published after 2015. Among the 26 countries represented, 16 were located in Africa. Most of the included countries implemented their HPV vaccination program in the 2010s, employing a variety of strategies, primarily mixed and school-based approaches. The cost per dose varied substantially, ranging from $6.66 to $82.78 for economic costs and from $5.69 to $51.21 for financial costs in 2023 USD. The studies reported costs across categories differently, with significant variation in the primary cost drivers of the vaccination programs.

The substantial variation in costs between countries may raise concerns about program performance. As many LMICs plan to introduce or expand HPV vaccination programs, understanding potential cost drivers and addressing these bottleneck issues that impede HPV vaccine uptake are essential for optimizing program effectiveness. From a methodological standpoint, it is crucial to develop and use a standardized tool for collecting cost data to facilitate cross-country comparisons.