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.
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