Table 1 Selected cost variablesa

From: Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India

Variable Base case
Vaccine costs b
 Cost per vaccinated individual 50.00
 Vaccine cost (three doses × unit cost) 36.74
 Vaccine wastage 5.51
 Freight, supplies, supply wastage, and administration 2.81
 Monitoring and programmatic services 2.94
 Cold chain, injection safety, operational costs 2.00
Screening, diagnostic, and treatment costs c , d
 HPV DNA test 10.30
 Cytology 3.69
 Visual inspection with acetic acid 1.25
 Colposcopy and biopsy 40.30
 Cryotherapy 16.00
 Loop electrosurgical excision procedure 106.99
 Cold knife conisation 237.02
 Simple hysterectomy 338.59
Invasive cervical cancer costs e
 Local 1611.57
 Regional/distant 2346.94
Patient time and transportation costs f
 Patient average hourly wage 0.30
 Screening visit 0.74
 Diagnostic visit 15.44
 Cryotherapy visit 0.76
 Loop electrosurgical excision procedure visit 15.49
 Cold knife conisation visit 24.57
 Simple hysterectomy visit 37.29
  1. aCosts reported in I$2005, a currency that provides a means of translating and comparing costs among countries, taking into account differences in purchasing power (WHO, 2001). We capitalised on data published previously for an analysis of screening alternatives in India (Goldie et al, 2005).
  2. bVaccine cost is expressed as a composite estimate of cost per vaccinated girl, and this total value is varied from I$5 to I$360 in sensitivity analysis; shown is the base case value. We assume the ‘cost per vaccinated girl’ includes three doses, vaccine wastage, freight into the country, supplies and administration, incremental programmatic costs for immunisation services, and incremental costs of social mobilisation and outreach for a new pre-adolescent vaccine (see Supplementary Appendix).
  3. cScreening costs include staff time, supplies, HPV DNA assay or Papanicolau test, and specimen transport. Diagnostic and treatment costs include staff time, supplies, and equipment depreciation; treatment includes cost of follow-up visits and complications. The cost of the HPV DNA test (i.e., hybrid capture test) was based on a previous analysis (Goldie et al, 2005). As this cost was intended to reflect an eventual negotiated price for developing countries, we assumed the same cost for the rapid test and decreased it by 50% in sensitivity analysis.
  4. dModel parameters were varied ±75% in sensitivity analysis.
  5. eInvasive cancer costs include both direct medical and direct non-medical costs. Direct medical costs of cancer care include staging of cancer severity, hospitalisation, stage-appropriate treatment, and follow-up visits. Direct non-medical costs and time costs associated with cancer care include all patient time in transport, waiting, receiving treatment, and hospitalisation as well as actual transport costs.
  6. fNon-medical costs include the time costs for two-way travel, waiting at the clinical site, and receiving treatment, and the cost of transport for an average of two follow-up visits. Screening and cryotherapy visits are carried out at a primary health clinic, whereas all other visits occur at a district hospital (see Supplementary Appendix). HPV, human papillomavirus.