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Annual Regional Conference on Immunization (ARCI) 10-12 December 2012, Dar es Salaam, Tanzania 1 |1 | Comprehensive WHO Cervical Cancer Control Costing.

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Presentation on theme: "Annual Regional Conference on Immunization (ARCI) 10-12 December 2012, Dar es Salaam, Tanzania 1 |1 | Comprehensive WHO Cervical Cancer Control Costing."— Presentation transcript:

1 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 1 |1 | Comprehensive WHO Cervical Cancer Control Costing and Planning (C4P) tool: findings from African countries Raymond Hutubessy PhD Initiative for Vaccine Research (IVR) team Immunization, Vaccines and Biological (IVB) department

2 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 2 |2 | Outline  General description of the comprehensive WHO Cervical Cancer Prevention and Control Costing (C4P) tool  Country examples: –Tanzania – 5-years planned scaling up costs of HPV vaccines –Rwanda – 1 year retrospective national costs of HPV vaccines  Lessons learned  Conclusions

3 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 3 |3 | Introduction  Tool was developed for Tanzania in response to vaccine donation –Local economists, MoHSW*, WHO Tanzania & HQ*, consultants involved –4 Country visits to collect data/interviews and workshops required  Tool addresses costing and planning issues –Economic and financial perspective –Input for Cost-Effectiveness Analysis and Financial Analysis  Excel-based model –Choice of inputs on strategies and assumptions –Spreadsheets with data on population and infrastructure: –Summary Page on Total Costs  Two modules of the generic tool –HPV Vaccine Module (version 1.0 available) –Cervical Cancer Screening and Treatment Module (available 2Q2013) * Including representatives from EPI and Reproductive Health

4 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 4 |4 | Purpose of Costing and Planning Tool  Assist planners to: –Estimate the cost of introducing a cervical cancer prevention and control programme in a country. –Understand the cost implications of adopting various alternatives of cervical cancer prevention and control approaches and strategies.

5 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 5 |5 | Designed for:  Programme Managers: –Ministries of Health –Reproductive Health –Maternal and Child Health –Immunization •Policy Makers •Donors

6 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 6 |6 | Users get a prospective 5-year cost estimate in exchange for their inputs.  Programme Cost Estimate Summary –Financial vs. Economic Costs –5-year costs by year –Activity cost breakdowns by: 1.Procurement 2.Training 3.Service Delivery 4.Social Mobilisation and IEC 5.Monitoring and Evaluation 6.Other

7 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 7 |7 | Approach to Costing  Ingredients Approach  Government perspective  Financial versus Economic analysis  Multi-level: national, regional, district, community  Incremental cost to existing reproductive health services

8 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 8 |8 | Costs represent the value of resources used for cervical cancer prevention and control –Financial costs represent the actual expenditure on goods and services purchased. •Use for financial analysis (affordability, budget allocation) •Perspective of individual payers e.g. MoH –Economic costs Recognize that cost of using resources also means that these resources are then unavailable for productive use elsewhere and effectively being tied-up •Concept of opportunity costs, which is the lost opportunity involved in using resources in one place rather than another •Use for cost-effectiveness analysis (value for money, sustainability) •Perspective of the society * WHO Guidelines for estimating costs of introducing new vaccines into the national immunization system

9 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 9 |9 | Three types of Costs  Introduction (Start-up) Costs –Micro planning –Training –Social Mobilization and IEC  Recurrent (Operational) Costs –Vaccine and Injection Supplies –Service Delivery •Per Diems, Transport, communications –Supervision, Monitoring and Evaluation –Other (e.g. waste management)  Capital Costs –Cold chain equipment

10 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 10 | Pillars of Tanzania’s CxCa strategic plan  Vaccination of adolescent girls (P4) before they become sexually active  Screening of women aged 30 to 50 years and treatment of precancerous lesions  Diagnosis, care and treatment including palliative care for cervical cancer patients

11 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 11 | Objectives and assumptions of planned HPV vaccination for Tanzania  Objective: to estimate and project incremental costs to health system of introducing HPV vaccine –Assess the financial and economic costs of resources required for delivering a new vaccine to a non-traditional population using different delivery strategies  Assumptions –Scaling-up: 1 st year 3 regions; 2 nd year 10 regions; 3 yr all 26 regions –Girls aged 10 years will be vaccinated –Vaccine: •Financial analysis: vaccines donated •Economic analysis: unit costs of $5 (maximum GAVI price) •5% wastage and 25% buffer stock –Projected cost over five years –Assume no capital good are needed since already available for other vaccines

12 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 12 | Summary of expected outputs of introducing HPV vaccines in Tanzania, Output Total Target population 80,290349,349646,936672,833694,6662,444,074 Doses used a 181,878791,3621,471,3081,524,1351,573,5915,542,274 Fully immunized girls 52,209227,164422,345437,510451,7061,590,934 Health workers trained 1,4723,5965, ,138 Health facilities mobilized 7361,7982,535005,069 School vaccination sites added 2,0986,3337, ,158 Schools sensitized 2,0986,3337, ,158

13 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 13 | School vs health facility based

14 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 14 | Five-year average cost per dose and Fully Immunized Girl (FIG) - Tanzania Financial CostEconomic Cost Total cost per dose$5.68$10.62 Delivery cost per dose (without vaccine) $1.66$3.56 Total cost per FIG$19.79 $37.01 Delivery cost per FIG (without vaccine) $5.77$12.40

15 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 15 | HPV introduction in Rwanda in 2011  HPV donation Merck  3 national campaigns  School-based (P6 girls) and facility based (12yrs girls)  Assumptions

16 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 16 | Annual costs Rwanda – preliminary results

17 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 17 | One-year average cost per dose and Fully Immunized Girl (FIG) - Rwanda Financial CostEconomic Cost Total cost per dose$3.82$11.59 Delivery cost per dose (without vaccine) $3.26$4.60 Total cost per FIG$11.69 $35.49 Delivery cost per FIG (without vaccine) $9.97$14.09

18 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 18 | LESSONS LEARNED

19 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 19 | HPV vaccine price vs delivery costs  Indicative HPV vaccine price for GAVI countries is 5 US$ (a 64% reduction on the lowest public price)  In addition, countries would need to secure about $3-5 per girl for 1 st year start-up costs and $4-6 per fully immunized girl for operational costs of vaccine delivery Source: Hutubessy et al. A case study using The United Republic of Tanzania: Costing nationwide HPV vaccine delivery using the WHO Cervical Cancer Prevention and Control Costing Too (2012). BMC Medicine (in publication)

20 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 20 | Non-Vaccine (Delivery) Cost per Infant Varies by Region (%) Source: Brenzel, L. et al (2012)

21 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 21 | HICsMICsLICs Vaccine costs Delivery costs Global trends on relative vaccine vs delivery costs

22 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 22 | C4P and other WHO economic tools and initatives  cMYP Costing and Financing tool –Consistent costing methods and approaches –C4P provides adds-on and more details on HPV vaccination introduction and recurrent costs over 5 year planning period –Integration in cMYP in future?  OneHealth Tool* – –For the first time, planners have a single framework for planning, costing, impact analysis, budgeting and financing of strategies for all major diseases and health system components. –Integration of C4P tool including a Cost-Effectiveness component (PRIME)  International Working Group (IWG) ProVac –C4P workshop organized in AFR and WPR in 2013 as part of capacity building on using economic tools and information for vaccine introduction decisions *

23 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 23 | •Field tested in Tanzania and Rwanda and validated with PATH demonstration projects. •C4P workshop in July 2011 in Dar es Salaam to inform national budget for HPV introduction. •Costing and CEA workshops in regional WHO meetings in EUR (Oct11), AMR (Nov11), WPR (End Nov11), AFR (June 2012) •C4P tool use and development workshop in 6- 7 December 2011, WHO-HQ, Geneva with participants from 5 WHO regions and partners – 2 representatives from AFR •2012: Vaccination module reviewed and endorsed by WHO Advisory Committee on implementation research (IVIR). WHO C4P applications up to now

24 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 24 | Vaccination Module in BMC Medicine

25 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 25 | Conclusion  WHO C4P Costing tool –Allow calculation of costs of various scenarios of cervical cancer prevention and control •Calculate total costs for budgetary purposes •Compare costs of various strategies: e.g. school-based vs. campaigns, treatment options by level •Compare average costs across local levels, different strategies  Increase sense of ownership of process and output  Provide greater transparency, validity, and reliability in planning and costing of program tasks

26 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 26 |  Detailed national delivery cost information from LMICs are lacking – to address national program affordability and sustainability this information is crucial, also for resource mobilization  In MIC (non-GAVI eligible countries) both vaccine procurement and delivery program costs may be a barrier  HPV vaccines may be cost-effective but not affordable in LMICs Overall conclusions

27 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 27 | Acknowledgments  MoHSW Tanzania –Dafrossa Lyimo –Safina Yuma – Mariam Ally  MOH Rwanda –Fidele Ngabo –Maurice Gatera  WHO Consultants –Ann Levin (Indep. Consult.) –Winn Morgan (Indep. Consult.) –Mark Jit (HPA, UK)  WHO Tanzania –Theopista John –Chris Kamugisha  WHO AFR –Carol Tevi Benissan –Richard Mihigo  WHO Geneva –Nathalie Broutet (WHO/RHR) –Susan Wang (WHO/IVB)  Financial support by GAVI Alliance

28 Annual Regional Conference on Immunization (ARCI) December 2012, Dar es Salaam, Tanzania 28 | THANK YOU More information:  Raymond Hutubessy, WHO IVB Geneva, Switzerland  Tool including user guide soon available on WHO NUVI HPV website es/en/index.html es/en/index.html


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